Age and Race Differences in the Association Between Social Support and Leisure-Time Physical Activity Among Adults With Cognitive Difficulty: Evidence From the 2023 BRFSS

Purpose To examine the association between perceived social/emotional support (PSES) and leisure-time physical activity (LTPA) among U.S. adults with self-reported cognitive disabilities, and to explore moderation by age and race. Design Cross-sectional analysis of 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. Setting U.S., nationally representative telephone survey. Sample 15 326 non-institutionalized adults with self-reported cognitive disability based on a BRFSS item. Measures Primary exposure was self-reported PSES (good, medium, poor). Outcome was LTPA (yes/no). Covariates included race/ethnicity, age, sex, education, smoking status, household income, health insurance, depressive disorder, physical health, and mental health. Analysis Survey-weighted bivariate analyses and multivariable logistic regression examined associations between LTPA and PSES. Adjusted logistic regression models tested the moderating effects of age on association between PSES and LTPA, stratified by race/ethnicity. Results In adjusted models, adults reporting poor vs good support had higher odds of physical inactivity (OR = 1.33, 95% CI: 1.08-1.63). Significant moderation was observed: among Black adults aged 55-64, poor support was linked to more than 2-fold higher odds of inactivity (poor vs good: OR = 2.79, 95% CI: 1.24-6.32; medium vs good: OR = 2.07, 95% CI: 1.15-3.76); among White adults, associations persisted across multiple age groups. Conclusion Higher PSES was associated with greater LTPA among adults with cognitive disabilities, with variation by age and race. Interventions should integrate culturally tailored support strategies.