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Risk Factor: Documentation
Risk Factor Type: Behavior, Metabolic
Notes:
View documentation for background information on the putative mechanisms by which physical activity may influence AD risk, findings from related investigations of cognitive decline and randomized trials of physical activity, and challenges in this area of research.
Status: Updated 16 September 2009


Table 1:   Physical activity-categorical
Notes This table represents a variety of exposure definitions for leisure-time physical activity in relation to AD risk. Generally, the reference category corresponds to the least amount of physical activity; however, in the Abbott 2004 paper the reference category is represented by those with the highest number of miles walked per day.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Abbott, 2004 HAAS Incidence study reporting hazard ratios (HRs) 2257
(0%)
7.0 y
(detail)
<.25 miles/d: 27%
.25 to 1 miles/d: 34%
>1 to 2 miles/d: 19%
>2 miles/d: 20%
(detail)
-
-
-
-
Total: 101
2.21
1.86
1.88
1.00
1.06-4.57
0.91-3.79
0.87-4.04
Ref.
0.03
0.09
0.11
Ref.
-
-
-
-
Total: 158
1.93
1.75
1.33
1.00
1.11-3.32
1.03-2.99
0.73-2.45
Ref.
0.02
0.04
0.35
Ref.
Japanese
(detail)
77 (4)
(71 - 93)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, APOE4, BMI, CHD, DM, HTN, O, PP, TC‡
(detail)
Abbott, 2004
Larson, 2006 ACT-GHC Incidence study reporting hazard ratios (HRs) 1740
(60%)
6.2 y
(detail)
<3 times/wk: 26%
>3 times/wk: 74%
(detail)
-
-
Total: 107
1.00
0.69
Ref.
0.45-1.05
Ref.
0.08
52
106
Total: 158
1.00
0.68
Ref.
0.48-0.96
Ref.
0.03
Caucasian, Other, African-American (Black)
(detail)
74 (6)
(65 - )
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, ALC, APOE4, CVD, CF, CHD, DEP, DM, DSU, HS, HTN, PP, SM‡§
(detail)
Larson, 2006
Laurin, 2001 CSHA Cumulative incidence study reporting odds ratios (ORs) 4615
(60%)
5.0 y
(detail)
None: 32%
Low PA: 13%
Moderate PA: 36%
High PA: 19%
(detail)
80
21
52
16
Total: 169
1.00
0.67
0.67
0.50
Ref.
0.39-1.14
0.46-0.98
0.28-0.90
Ref.
0.14
0.04
0.02
*
110
28
79
31
Total: 248
1.00
0.64
0.69
0.63
Ref.
0.41-1.02
0.50-0.95
0.40-0.98
Ref.
0.05
0.02
0.04
*
Caucasian
(detail)
- (-)
(65 - )
(detail)
Screening: 3MSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Laurin, 2001
Podewils, 2005 CHCS Incidence study reporting hazard ratios (HRs) 3375
(59%)
5.4 y
(detail)
<248 kcal/week: 25%
248-742 kcal/wk: 25%
743-1,647 kcal/wk: 25%
>1,657 kcal/wk: 25%
(detail)
69
70
58
48
Total: 245
1.00
1.07
0.92
0.70
Ref.
0.73-1.57
0.62-1.39
0.44-1.33
Ref.
0.73
0.69
0.14
*
129
136
111
103
Total: 479
1.00
1.22
0.94
0.85
Ref.
0.93-1.60
0.69-1.28
0.61-1.19
Ref.
0.15
0.69
0.34
*
Caucasian, Other
75 (5)
(65 - )
Screening: IQ-CODE, 3MSE, Other, TICS

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, ADLI, APOE4, MMSE, IADLI, MRI, RE, SNS, SSS‡
(detail)
Podewils, 2005
Ravaglia, 2008 CSBA Incidence study reporting hazard ratios (HRs) 749
(54%)
3.9 y
(detail)
<4,774 kcal/wk: 33%
4,774-8,090 kcal/wk: 33%
>8.090 kcal/wk: 33%
(detail)
21
20
13
Total: 54
1.00
0.70
0.95
Ref.
0.33-1.49
0.50-1.80
Ref.
0.35
0.88
*
41
26
19
Total: 86
1.00
0.58
0.69
Ref.
0.32-1.06
0.41-1.15
Ref.
0.07
0.16
*
Caucasian
(detail)
73 (6)
(65 - )
Screening: MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, C, CVD, CPD, CHD, DM, HTN, HCY‡
(detail)
Ravaglia, 2008
Rovio, 2005 North Karelia Project/FINMONICA Cumulative incidence study reporting odds ratios (ORs) 1449
(62%)
21 y
(detail)
Sedentary in midlife: 59%
Active in midlife: 41%
(detail)
31
10
Total: 41
1.00
0.35
Ref.
0.16-0.80
Ref.
0.01
*
38
15
Total: 53
1.00
0.47
Ref.
0.25-0.90
Ref.
0.02
*
 (detail) 51 (6)
(39 - 64)
Screening: MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, ALC, APOE234, BMI, LD, MI, SM, SH, SBP, TC‡§
(detail)
Rovio, 2005
Scarmeas, 2009 WHICAP Incidence study reporting hazard ratios (HRs) 1880
(69%)
5.4 y
(detail)
No PA: 25%
Some PA: 36%
Much PA: 39%
(detail)
71
84
69
Total: 224
1.00
0.75
0.67
Ref.
0.54-1.04
0.47-0.95
Ref.
0.08
0.02
 
 
 
      Caucasian, Other, Hispanic, African-American (Black)
77 (7)
( - )
Screening: Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, Baseline B, Kcal, CF, CI, DEP, LA, O, RE, SM, SP‡
(detail)

Scarmeas, 2009
Wilson, 2002a ROS Incidence study reporting hazard ratios (HRs) 733
(67%)
4.5 y
(detail)
Lowest PA: 25%
Low-mid PA: 25%
Mid-high PA: 25%
Highest PA: 25%
(detail)
-
-
-
-
Total: 111
1.00
0.71
0.73
0.61
Ref.
0.42-1.19
0.44-1.20
0.35-1.05
Ref.
0.2
0.22
0.08
*
 
 
 
 
      Caucasian, Other
75 (6)
(65 - )
Screening: CERAD

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Wilson, 2002a
Yoshitake, 1995 Hisayama Study Incidence study reporting hazard ratios (HRs) 826
(60%)
6.1 y
*

(detail)
No PA: 63%
Yes: 37%
(detail)
-
-
Total: 44
1.00
0.20
Ref.
0.06-0.68
Ref.
0.01
*
 
 
Total: 103
      Japanese
(detail)
74 (6)
(65 - )
(detail)
Screening: HDS

AD Diagnosis: NINCDS ADRDA
(detail)
A, G‡
(detail)
Yoshitake, 1995
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ADLI" (activities of daily living impairment), "ALC" (alcohol intake), "APOE234" (APOE e2 e3 e4 genotype), "APOE4" (APOE e4 genotype), "Baseline B" (baseline BMI), "MMSE" (baseline MMSE), "BMI" (body mass index), "Kcal" (caloric intake), "C" (cancer), "CVD" (cardiovascular disease), "CPD" (chronic pulmonary disease), "CF" (cognitive function), "CI" (comorbidity index), "CHD" (coronary heart disease), "DEP" (depression), "DM" (diabetes mellitus), "DSU" (dietary supplement use), "HS" (health status), "HTN" (hypertension), "IADLI" (instrumental activities of daily living impairment), "LA" (leisure activities), "LD" (locomotor disorders), "MRI" (magnetic resonance imaging white-matter-grade score), "MI" (mycardial infarction history), "O" (other), "PP" (physical performance), "HCY" (plasma homocysteine), "RE" (race/ethnicity), "SM" (smoking status), "SNS" (social network score), "SSS" (social support score), "SH" (stroke history), "SP" (study population), "SBP" (systolic blood pressure), "TC" (total cholesterol)
§ Covariates for total dementia are different.
 
Table 2:   Physical activity-continuous
Notes These reports examine leisure-time physical activity modeled as a continuous variable (hours/week) in relation to AD risk.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time hrs/wk
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Wilson, 2002a ROS Incidence study reporting hazard ratios (HRs) 733
(67%)
4.5 y
(detail)
6 (8)
( - )
(detail)
111 1.00 0.97-1.02 1.0
*
        Caucasian, Other
75 (6)
(65 - )
Screening: CERAD

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡ Wilson, 2002a
Wilson, 2002b CHAP Cumulative incidence study reporting odds ratios (ORs) 835
(59%)
4.1 y
(detail)
4 (5)
( - )
(detail)
139 1.04 0.98-1.10 0.18
*
        Caucasian, African-American (Black)
(detail)
76 (4)
(65 - )
(detail)
Screening: Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, APOE4, RE, SS‡
(detail)
Wilson, 2002b
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "APOE4" (APOE e4 genotype), "RE" (race/ethnicity), "SS" (stratified sampling)
 
 
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