Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis

Abstract

Objective: To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia.

Design: Meta-analysis of 19 prospective observational cohort studies.

Data sources: The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies.

Review method: The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis.

Results: Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured <10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity ≥10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed >10 before dementia onset 1.30, 0.79 to 2.14).

Conclusions: In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

Fig 1

Selection of studies for individual-participant meta-analysis of the association between physical inactivity and dementia and Alzheimer’s disease

Fig 2

Change in hazard ratio for the association between physical inactivity at baseline (year 0) and risk of incident dementia and Alzheimer’s disease over the entire follow-up period (upper panel: follow-up-stratified analysis; lower panel: analysis of flexible parametric proportional-hazards)

Fig 3

Summary hazard ratios from individual-level meta-analysis of 19 cohort studies for the association of physical inactivity with risk of dementia, Alzheimer’s disease, and cardiometabolic disease during the first 10 years of follow-up and from year 10 onwards in those without the disease at year 10

Fig 4

Hazard ratios for the association of physical inactivity with risk of dementia in subgroups from individual-level meta-analysis of 19 cohort studies

Fig 5

Hazard ratios from pooled analysis of 5 cohort studies for a 3-level physical activity in relation to dementia, diabetes, coronary heart disease, and stroke during the first 10 years of follow-up and from year 10 onwards in those without the disease at year 10

Fig 6

Hazard ratios from pooled analysis of 5 cohort studies for the association of physical inactivity with incident dementia with and without preceding incident cardiometabolic disease in participants with no cardiometabolic disease at baseline and no dementia at year 10