Association between physical activity levels and motoric cognitive risk syndrome in Chinese older adults

To investigate the cross-sectional and longitudinal associations between physical activity levels (PAL) and motoric cognitive risk (MCR) syndrome in Chinese older adults. This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011–2015. Cross-sectional analysis included 1,721 participants and longitudinal analysis included 1,506 participants aged ≥ 60 years (mean follow-up: 3.68 years). PAL was quantified using metabolic equivalent of task (MET-minutes/week) and categorized as low (< 600), moderate (600-2,999), or high (≥ 3,000). MCR was defined by concurrent slow gait speed (> 1 SD below age- and sex-specific means) and subjective cognitive complaints. Multivariable logistic regression and Cox proportional hazards models were employed to examine association between PAL and MCR, with restricted cubic spline (RCS) analysis exploring dose-response relationships. Multivariate logistic regression analysis revealed that moderate and high PAL significantly reduced MCR risks compared with low PAL (moderate: OR = 0.47, 95% CI: 0.28–0.81, p = 0.006; high: OR = 0.62, 95% CI: 0.45–0.85, p = 0.003). Cox proportional hazards model demonstrated that high PAL was associated with a significantly lower hazard of incident MCR (HR = 0.55, 95% CI: 0.35–0.86, p = 0.009). RCS analysis identified a significant nonlinear dose-response relationship (p = 0.032), with optimal protective effects observed at 4,133 − 15,000 MET-minutes/week. Subgroup analyses showed particularly robust protective effects in individuals aged < 65 years, married individuals, those with depression, and chronic obstructive pulmonary disease (COPD) patients. Higher physical activity levels are independently associated with reduced MCR risks and incidence in Chinese older adults, exhibiting a nonlinear dose-response pattern. These findings support physical activity promotion as an accessible, cost-effective preventive strategy for MCR and subsequent dementia risk reduction in aging populations.