Physical activity and blood pressure as predictors of cognitive function in the all of us research program

Q: What are the key findings of this study?

Higher baseline physical activity (daily step count) was positively associated with better cognitive performance across multiple domains, including sustained attention (Grad-CPT) and cognitive control (Flanker-Task).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Cognitive function (n=3093). Intervention: Physical activity (daily step count) vs. Lower physical activity. Primary outcome: Cognitive performance on the Gradual Onset Continuous Performance Task (Grad-CPT) (β = 0.31 per 1,000 steps/day, 95% CI 0.18 to 0.44, p=<0.003).

Q: What does this research mean for the field?

Higher wearable-measured physical activity is positively associated with cognitive performance across multiple domains, whereas higher systolic blood pressure is negatively associated with cognitive task performance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine how wearable-measured daily physical activity and blood pressure trajectories spanning 14 years associate with multi-domain cognitive performance in adults.

Olaoluwa O. Okusaga; Yi-Sian Lin; Elizabeth Atkinson

doi:10.1038/s41598-026-74379-6

October 11, 2026Scientific ReportsOpen Access

Physical activity and blood pressure as predictors of cognitive function in the all of us research program

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Key result

Higher daily step count is linked to better cognitive performance across sustained attention and cognitive control.

β = +0.31 per 1,000 steps/day
95% CI 0.18 to 0.44
P<0.003
n=3,093

Why the study?

Most studies on physical activity and cognition relied on subjective, self-reported measures of physical activity, limiting understanding of objective associations with cognitive function.

Does higher physical activity over time improve cognitive function in adults?

Key Points

To determine how wearable-measured daily physical activity and blood pressure trajectories spanning 14 years associate with multi-domain cognitive performance in adults.
Analyzed data from N=3,093 adults (mean age 58.4 years) in the All of Us Research Program with Fitbit step counts and blood pressure collected between 2009 and 2023.
Assessed end-of-study cognition using the Gradual Onset Continuous Performance Task (Grad-CPT), Delay Discounting Task (DD-Task), Multiracial Emotional Recognition Task, and Flanker-Task.
Estimated associations and trajectories using linear mixed-effects models, causal mediation analysis, and longitudinal k-means clustering.
Baseline physical activity was positively associated with Grad-CPT (β = 0.31, 95% CI: 0.18 to 0.44), DD-Task (β = 0.05, 95% CI: 0.04 to 0.07), and Flanker-Task (β = 0.26, 95% CI: 0.17 to 0.35).
Baseline systolic blood pressure was negatively associated with DD-Task performance (β = -0.01, 95% CI: -0.02 to -0.004) and mediated 4.8% of the association between physical activity and DD-Task (ACME = 0.003, 95% CI: 0.001 to 0.005).
Longitudinal k-means clustering revealed 3 step trajectories (mean steps: 5108, 8875, and 14,161/day); participants in the 8875 and 14,161 groups scored higher on Grad-CPT, DD-Task, and Flanker-Task than those in the 5108 group.

Study Design

Type

Observational (n=3,093)

Multicenter

Yes

Structured PICO

Does higher physical activity over time improve cognitive function in adults?

P

Population

3,093 adults (mean age 58.4, 68.3% female) in the US All of Us Research Program with up to 14 years of objective physical activity and blood pressure data prior to cross-sectional cognitive testing.

E

Exposure

Higher physical activity (daily step count from Fitbit wearable devices)

C

Comparator

Lower physical activity (baseline status and long-term trajectories evaluated)

O

Outcome

End-of-study cognitive performance assessed by the Gradual Onset Continuous Performance Task (Grad-CPT), Delay Discounting Task (DD-Task), Multiracial Emotional Recognition Task (Emorecog-Task), and Flanker-Task.surrogate

Main Result

Mean Difference: 0.31 (95% CI 0.18–0.44)

p-value: p=<0.003

Limitations

Absence of a baseline cognitive assessment (reverse causation cannot be excluded)
Single cognitive measurement prevents estimation of within-person cognitive change
Inability to control for potential confounders such as obesity (body mass index), smoking, and mental illness diagnosis
Task administration was not counterbalanced, which may introduce order effects like practice or fatigue
Absence of baseline cognitive assessment
Single cognitive measurement prevents estimation of cognitive change
Inability to control for other potential confounders such as BMI, smoking, and mental illness
Self-selected task order without counterbalancing

Implication

Objective physical activity data spanning up to 14 years positively correlates with late-study cognitive performance, underscoring the role of lifestyle behavior in long-term cognitive health.

Abstract

Physical activity (PA) is positively associated with cognition, whereas elevated blood pressure shows a negative association. However, most studies relied on subjective, self-reported measures of PA. In this study, we examined associations of PA (daily step count from Fitbit wearable devices), systolic (SBP) and diastolic (DBP) blood pressure spanning 14 years, with end-of-study cognitive performance in 3,093 participants in the All of Us Research Program (AoU). Cognition was assessed by the Gradual Onset Continuous Performance Task (Grad-CPT), Delay Discounting Task (DD-Task), Multiracial Emotional Recognition Task (Emorecog-Task) and Flanker-Task. Baseline PA metrics were positively associated with Grad-CPT (β = 0.31, 95% CI: 0.18 to 0.44), DD-Task (β = 0.05, 95% CI: 0.04 to 0.07), and Flanker-Task (β = 0.26, 95% CI: 0.17 to 0.35). Baseline SBP was negatively associated with DD-Task (β = -0.01, 95% CI: -0.02 to -0.004). Longitudinal k-means clustering identified 3 clusters of individuals—A, B and C— with mean daily steps of 5108, 8875 and 14,161 respectively. Individuals in clusters B and C had higher scores than those in cluster A on the DD-Task, Grad-CPT and Flanker-Task. These findings underscore the potential role of PA promotion and optimal blood pressure management in supporting cognitive health.

Discussion

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Cite This Study

Okusaga et al. (2026) conducted an observational in Cognitive function (n=3,093). Physical activity (daily step count) vs. Lower physical activity was evaluated on Cognitive performance on the Gradual Onset Continuous Performance Task (Grad-CPT) (β = 0.31 per 1,000 steps/day, 95% CI 0.18 to 0.44, p=<0.003). Higher baseline physical activity (daily step count) was positively associated with better cognitive performance across multiple domains, including sustained attention (Grad-CPT) and cognitive control (Flanker-Task).

synapsesocial.com/papers/6acda56697e176cf4084dcc5 https://doi.org/10.1038/s41598-026-74379-6

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Physical activity and blood pressure as predictors of cognitive function in the all of us research program

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Physical activity and blood pressure as predictors of cognitive function in the all of us research program

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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