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Original Investigation |

Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function

Tina D. Hoang, MSPH1; Jared Reis, PhD2; Na Zhu, MD, MPH3; David R. Jacobs Jr, PhD3; Lenore J. Launer, PhD4; Rachel A. Whitmer, PhD5; Stephen Sidney, MD5; Kristine Yaffe, MD6,7
[+] Author Affiliations
1Northern California Institute for Research and Education, San Francisco
2Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
3Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis
4Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland
5Division of Research, Kaiser Permanente of Northern California, Oakland
6Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco
7San Francisco Veterans Affairs Medical Center, San Francisco, California
JAMA Psychiatry. 2016;73(1):73-79. doi:10.1001/jamapsychiatry.2015.2468.
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Importance  Sedentary behaviors and physical inactivity are not only increasing worldwide but also are critical risk factors for adverse health outcomes. Yet, few studies have examined the effects of sedentary behavior on cognition or the long-term role of either behavior in early to middle adulthood.

Objective  To investigate the association between 25-year patterns of television viewing and physical activity and midlife cognition.

Design, Setting, and Participants  Prospective study of 3247 adults (black and white races; aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (March 25, 1985, to August 31, 2011). Data analysis was performed June 1, 2014, through April 15, 2015.

Main Outcomes and Measures  We assessed television viewing and physical activity at repeated visits (≥3 assessments) over 25 years using a validated questionnaire. A 25-year pattern of high television viewing was defined as watching TV above the upper baseline quartile (>3 hours/d) for more than two-thirds of the visits, and a 25-year pattern of low physical activity was defined as activity levels below the lower, sex-specific baseline quartile for more than two-thirds of the of the visits. We evaluated cognitive function at year 25 using the Digit Symbol Substitution Test (DSST), Stroop test, and Rey Auditory Verbal Learning Test.

Results  At baseline, the mean (SD) age of the 3247 study participants was 25.1 (3.6) years, 1836 (56.5%) were female, 1771 (54.5%) were white, and 3015 (92.9%) had completed at least high school. Compared with participants with low television viewing, those with high television viewing during 25 years (353 of 3247 [10.9%]) were more likely to have poor cognitive performance (<1 SD below the race-specific mean) on the DSST and Stroop test, with findings reported as adjusted odds ratio (95% CI): DSST, 1.64 (1.21-2.23) and Stroop test, 1.56 (1.13-2.14), but not the Rey Auditory Verbal Learning Test, adjusted for age, race, sex, educational level, smoking, alcohol use, body mass index, and hypertension. Low physical activity during 25 years in 528 of 3247 participants (16.3%) was significantly associated with poor performance on the DSST, 1.47 (1.14-1.90). Compared with participants with low television viewing and high physical activity, the odds of poor performance were almost 2 times higher for adults with both high television viewing and low physical activity in 107 of 3247 (3.3%) (DSST, 1.95 [1.19-3.22], and Stroop test, 2.20 [1.36-3.56]).

Conclusions and Relevance  High television viewing and low physical activity in early adulthood were associated with worse midlife executive function and processing speed. This is one of the first studies to demonstrate that these risk behaviors may be critical targets for prevention of cognitive aging even before middle age.

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Figure.
Combined Pattern of Physical Activity and Television Viewing Time and Poor Cognitive Performance

Models were adjusted for age, race, sex, educational level, smoking, alcohol use, body mass index, and hypertension. The most active (reference) group had a long-term pattern of moderate to high physical activity and low to moderate television viewing time; the intermediate group had a long-term pattern of moderate to high physical activity and high television viewing time or long-term pattern of low physical activity and low to moderate television viewing time; and the least active group had a long-term pattern of low physical activity and high television viewing time. DSST indicates Digit Symbol Substitution Test; RAVLT, Rey Auditory Verbal Learning Test; circles, odds ratios; and error bars, 95% CI.

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