Physical exercise and cognitive function across the life span: Results of a nationwide population-based study

Published:September 06, 2017DOI:



      To examine cross-sectional and longitudinal associations between physical exercise and cognitive function across different age groups in a nationwide population-based sample of adults aged 18–79 years in Germany.




      Cognitive function was assessed in the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009–2012, n = 3535), using a comprehensive neuropsychological test battery. Cognitive domain scores for executive function and memory were derived from confirmatory factor analysis. Regular physical exercise in the last three months was assessed by self-report and defined as no exercise, <2 and ≥2 h (hours) of exercise per week. A subgroup of DEGS1-MH participants who previously participated in the German National Health Interview and Examination Survey 1998 (GNHIES98, 1997–1999, n = 1624) enabled longitudinal analyses with a mean follow-up of 12.4 years.


      Compared to no exercise, more weekly physical exercise was associated with better executive function in cross-sectional (<2 h: β = 0.12; ≥2 h: β = 0.17; all p < 0.001) and longitudinal analyses (<2 h: β = 0.14, p < 0.001; ≥2 h: β = 0.15, p = 0.001) using linear regression models adjusted for age, sex, education, smoking, alcohol consumption, fruit and vegetable consumption and obesity. Slightly weaker associations were found for memory in cross-sectional (<2 h: β = 0.08, p = 0.009; ≥2 h: β = 0.08, p = 0.026) and longitudinal analysis (<2 h: β = 0.09, p = 0.036; ≥2 h: β = 0.08, p = 0.114). There was no evidence of interaction between physical exercise and age.


      Higher levels of physical exercise were associated with better executive function and memory in cross-sectional and longitudinal analyses with no evidence for differential effects by age.


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        • Winblad B.
        • Amouyel P.
        • Andrieu S.
        • et al.
        Defeating Alzheimer’s disease and other dementias: a priority for European science and society.
        Lancet Neurol. 2016; 15: 455-532
        • Prince M.
        • Wimo A.
        • Guerchet M.
        • et al.
        World Alzheimer report 2015: the global impact of dementia.
        Alzheimer’s Disease International (ADI), London2015
        • Wu Y.T.
        • Fratiglioni L.
        • Matthews F.E.
        • et al.
        Dementia in western Europe: epidemiological evidence and implications for policy making.
        Lancet Neurol. 2016; 15: 116-124
        • Carvalho A.
        • Rea I.M.
        • Parimon T.
        • et al.
        Physical activity and cognitive function in individuals over 60 years of age: a systematic review.
        Clin Interv Aging. 2014; 9: 661-682
        • Blondell S.J.
        • Hammersley-Mather R.
        • Veerman J.L.
        Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies.
        BMC Public Health. 2014; 14: 510
        • Cox E.P.
        • O’Dwyer N.
        • Cook R.
        • et al.
        Relationship between physical activity and cognitive function in apparently healthy young to middle-aged adults: a systematic review.
        J Sci Med Sport. 2016; 19: 616-628
        • Dik M.
        • Deeg D.J.
        • Visser M.
        • et al.
        Early life physical activity and cognition at old age.
        J Clin Exp Neuropsychol. 2003; 25: 643-653
        • Dregan A.
        • Gulliford M.C.
        Leisure-time physical activity over the life course and cognitive functioning in late mid-adult years: a cohort-based investigation.
        Psychol Med. 2013; 43: 2447-2458
        • Kareholt I.
        • Lennartsson C.
        • Gatz M.
        • et al.
        Baseline leisure time activity and cognition more than two decades later.
        Int J Geriatr Psychiatry. 2011; 26: 65-74
        • Jacobi F.
        • Mack S.
        • Gerschler A.
        • et al.
        The design and methods of the mental health module in the German Health Interview and Examination Survey for Adults (DEGS1-MH).
        Int J Methods Psychiatr Res. 2013; 22: 83-99
        • Scheidt-Nave C.
        • Kamtsiuris P.
        • Goesswald A.
        • et al.
        German health interview and examination survey for adults (DEGS) – design, objectives and implementation of the first data collection wave.
        BMC Public Health. 2012; 12: 730
        • Bellach B.M.
        • Knopf H.
        • Thefeld W.
        The German Health Survey. 1997/98.
        Gesundheitswesen. 1998; 60: S59-S68
        • Thefeld W.
        • Stolzenberg H.
        • Bellach B.M.
        The Federal Health Survey: response, composition of participants and non-responder analysis.
        Gesundheitswesen. 1999; 61: S57-S61
        • Von Aster M.
        • Neubauer A.
        • Horn R.
        Wechsler-Intelligenztest für Erwachsene. WIE – manual.
        Harcourt Test Services, Frankfurt/M2006
        • Reitan R.M.
        The validity of the Trail Making Test as an indicator of organic brain damage.
        Percept Mot Skills. 1958; 8: 271-276
        • van der Elst W.
        • van Boxtel M.P.
        • van Breukelen G.J.
        • et al.
        The letter digit substitution test: normative data for 1858 healthy participants aged 24–81 from the Maastricht Aging Study (MAAS): influence of age, education, and sex.
        J Clin Exp Neuropsychol. 2006; 28: 998-1009
        • Luck T.
        • Riedel-Heller S.G.
        • Wiese B.
        • et al.
        CERAD-NP battery: age-, gender- and education-specific reference values for selected subtests. Results of the German study on ageing, cognition and dementia in primary care patients (AgeCoDe).
        Z Gerontol Geriatr. 2009; 42: 372-384
        • Morris J.C.
        • Heyman A.
        • Mohs R.C.
        • et al.
        The consortium to establish a registry for Alzheimer’s disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease.
        Neurology. 1989; 39: 1159-1165
        • Wagner M.
        • Wolfsgruber S.
        • Gaertner B.
        • et al.
        Cognitive functioning in the general population: factor structure and association with mental disorders – the neuropsychological test battery of the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH).
        Int J Methods Psychiatr Res. 2017; ([in press])
        • Finger J.D.
        • Busch M.A.
        • Du Y.
        • et al.
        Time trends in cardiometabolic risk factors in adults.
        Dtsch Arztebl Int. 2016; 113: 712-719
        • World Health Organization
        Global recommendations on physical activity for health.
        World Health Organization, Geneva2010
        • Müller W.
        • Lüttinger P.
        • König W.
        • et al.
        Class and education in industrial nations.
        Int J Sociol. 1989; 19: 3-39
        • Burger M.
        • Bronstrup A.
        • Pietrzik K.
        Derivation of tolerable upper alcohol intake levels in Germany: a systematic review of risks and benefits of moderate alcohol consumption.
        Prev Med. 2004; 39: 111-127
        • Mensink G.B.
        • Beitz R.
        Food and nutrient intake in East and West Germany, 8 years after the reunification – the German Nutrition Survey 1998.
        Eur J Clin Nutr. 2004; 58: 1000-1010
        • Sallis J.F.
        • Bull F.
        • Guthold R.
        • et al.
        Progress in physical activity over the Olympic quadrennium.
        Lancet. 2016; 388: 1325-1336
        • Lee Y.
        • Back J.H.
        • Kim J.
        • et al.
        Systematic review of health behavioral risks and cognitive health in older adults.
        Int Psychogeriatr. 2010; 22: 174-187
        • van Uffelen J.G.
        • Chin A.P.M.J.
        • Hopman-Rock M.
        • et al.
        The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review.
        Clin J Sport Med. 2008; 18: 486-500
        • Erickson K.I.
        • Voss M.W.
        • Prakash R.S.
        • et al.
        Exercise training increases size of hippocampus and improves memory.
        Proc Natl Acad Sci U S A. 2011; 108: 3017-3022
        • Thomas A.
        • Dennis A.
        • Bandettini P.
        • et al.
        The effects of aerobic activity on brain structure.
        Front Psychol. 2012; 3
        • Davis J.C.
        • Bryan S.
        • Marra C.A.
        • et al.
        Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia.
        Br J Sports Med. 2015; 49: 1343-1347
        • Colcombe S.
        • Kramer A.F.
        Fitness effects on the cognitive function of older adults: a meta-analytic study.
        Psychol Sci. 2003; 14: 125-130
        • Wang C.
        • Yu J.T.
        • Wang H.F.
        • et al.
        Non-pharmacological interventions for patients with mild cognitive impairment: a meta-analysis of randomized controlled trials of cognition-based and exercise interventions.
        J Alzheimers Dis. 2014; 42: 663-678
        • Young J.
        • Angevaren M.
        • Rusted J.
        • et al.
        Aerobic exercise to improve cognitive function in older people without known cognitive impairment.
        Cochrane Database Syst Rev. 2015; 4: CD005381
        • Ngandu T.
        • Lehtisalo J.
        • Solomon A.
        • et al.
        A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial.
        Lancet. 2015; 385: 2255-2263
        • Wu Y.T.
        • Prina A.M.
        • Brayne C.
        The association between community environment and cognitive function: a systematic review.
        Soc Psychiatry Psychiatr Epidemiol. 2015; 50: 351-362