Association Between Physical Activity During Active Commuting and Leisure Time With Cognitive Decline: Findings of the ELSA-Brasil Study

BACKGROUND: Studies examining the relationship between physical activity (PA) domains and cognitive decline are scarce. We examined the association between PA performed during leisure time and active commuting with cognitive decline in middle-aged and older adults. METHODS: We analyzed data from the Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) study. Participants were enrolled between 2008 and 2010, with a follow-up visit between 2017 and 2019. Baseline PA during leisure time and active commuting were assessed. We evaluated memory, language, and executive function at baseline and follow-up. Cognitive decline was defined as a difference in cognitive score at follow-up from the baseline mean and SD. Cognitive impairment was defined using normative values. RESULTS: Participants (n = 10,412, 51.0 [8.9] y; 56% female) were followed over a mean follow-up of 8.1 (0.6) years. Dose-response analyses revealed nonlinear and domain-specific associations. Leisure PA was associated with better baseline cognitive performance and a lower risk of cognitive impairment. Participants classified as active (≥150 min/wk) in leisure had a lower risk of cognitive impairment compared with participants with 0 minutes per week (relative risk = 0.85; 95% CI, 0.75-0.96). In contrast, commuting PA particularly at higher levels was associated with lower baseline cognitive performance and a higher risk of cognitive impairment (relative risk = 1.15; 95% CI, 1.01-1.31). Active commuters also showed a slower decline in executive function over time (β = 0.05; 95% CI, 0.01-0.09), although scores remained lower throughout follow-up. CONCLUSION: These findings underscore the importance of considering the context in which PA occurs when designing interventions to promote cognitive health.