Key result
Higher estimated cardiorespiratory fitness linked to ~28% greater odds of cognitive decline in Chinese adults.
Why the study?
The association between estimated cardiorespiratory fitness and cognitive trajectories may differ across populations, but cross-cultural evidence remains limited.
Does higher estimated cardiorespiratory fitness improve cognitive trajectories in middle-aged and older adults?
Cohort (n=10,363)
Yes
Does higher estimated cardiorespiratory fitness improve cognitive trajectories in middle-aged and older adults?
Odds Ratio: 1.28 (95% CI 1.16–1.43)
The association between estimated cardiorespiratory fitness and cognitive trajectories diverges significantly between Chinese and U.S. older adults, likely due to differences in occupational versus leisure-time physical activity.
Should not yet change practice for cognitive health; leaves open whether occupational versus leisure activity drives cross-national heterogeneity.
INTRODUCTION: The association between cardiorespiratory fitness (CRF) and cognition may differ across populations, but cross-cultural evidence remains limited. We explored whether estimated CRF (eCRF) shows divergent associations with cognitive trajectories in Chinese and U.S. middle-aged and older adults. METHODS: We included 3458 participants from CHARLS and 6905 from HRS. Cognitive trajectories were identified using latent class growth modelling. eCRF was estimated using sex-specific non-exercise algorithms. The unit of eCRF is metabolic equivalents of task (MET). Multinomial logistic regression examined the association between eCRF (per 1-MET increase) and trajectory membership, with the persistently high trajectory as the reference. RESULTS: Three cognitive trajectories-persistently high, moderate, and low-were identified in both cohorts. In CHARLS, higher eCRF was unexpectedly associated with increased odds of the low (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.16-1.43) and moderate (OR = 1.10, 95% CI: 1.03-1.18) trajectories. In HRS, higher eCRF was associated with lower odds of the moderate trajectory (OR = 0.94, 95% CI: 0.90-0.98), with no significant association for the low trajectory. DISCUSSION: This descriptive observation reveals divergent associations in the eCRF-cognition relationship between Chinese and U.S. adults, but should be interpreted cautiously. The finding persisted across multiple sensitivity analyses. However, given the lack of direct CRF measurement and objective assessment of activity type, we cannot distinguish whether this divergence reflects measurement differences and residual confounding, or true biological heterogeneity. Context-specific validation of eCRF equations and objective activity-specific measures are needed to clarify eCRF's role in cognitive aging.
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Ma et al. (2026) conducted a cohort in Cognitive decline (n=10,363). Estimated cardiorespiratory fitness (eCRF) vs. Lower estimated cardiorespiratory fitness was evaluated on Low cognitive trajectory (CHARLS cohort) (OR 1.28, 95% CI 1.16-1.43). Higher estimated cardiorespiratory fitness was associated with increased odds of low cognitive trajectories in Chinese adults (OR 1.28) but lower odds of moderate trajectories in U.S. adults (OR 0.94).
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