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体力活动与轻度认知障碍老年人认知功能的剂量效应关系研究

  • 魏贤军1

    机 构：

    1. 南京财经大学 体育部,南京 210046

    ×
  • ，张玉2

    机 构：

    2. 齐鲁师范学院 体育学院,济南 250200

    ×

1. 南京财经大学 体育部,南京 210046；
2. 齐鲁师范学院 体育学院,济南 250200；

Study on the Dose-effect Relationship between Physical Activity and Cognitive Function in the Elderly with Mild Cognitive Impairment

  • WEI Xianjun1

    Affiliation：

    1. Ministry of Sports,Nanjing University of Finance and Economics,Nanjing 210046 ,China

    ×
  • ，ZHANG Yu2

    Affiliation：

    2. Faculty of Physical Education, Qilu Normal University,Jinan 250200 ,China

    ×

1. Ministry of Sports,Nanjing University of Finance and Economics,Nanjing 210046 ,China；
2. Faculty of Physical Education, Qilu Normal University,Jinan 250200 ,China；

作者简介:

魏贤军(1975—),男,江苏徐州人,讲师,硕士,研究方向为运动人体科学。

中图分类号:G804.5

文献标识码:A

文章编号:1008-3596(2022)02-0075-08

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目录contents

    摘要

    目的:基于客观测量的体力活动,探讨体力活动与老年人认知能力之间的剂量效应关系。方法:采用 ActiGraphGT3X+测量老年人的体力活动,通过 《简易精神状态评价量表》中国版评定老年人的认知能力,利用线性回归模型分析体力活动与老年人认知能力之间的剂量效应关系。结果:在 600名受试者中,体力活动和认知能力测试数据均完整有效的共512名 (男245名,女267名),线性回归分析结果显示,校正了年龄、BMI、最高学历、月平均收入因素后,MVPA 对老年人认知能力产生显著影响 (P＜0.01),且对女性的改善效果好于男性 (标准化系数0.693＞0.548);LPA 仅对女性老年人认知能力影响显著 (P＜0.01)。将 MVPA 按照四分位数间距分成4组时发现,MVPA 与老年人认知能力之间存在倒 “U”型剂量效应关系,在 4 个模型中,Q2 组 (21.13 min/day≤ MVPA＜34.49min/day)MVPA 对认知能力影响的β系数大于其他三组,并未发现 LPA 与女性老年人之间呈现规律的剂量效应关系。结论:体力活动能显著改善老年人的认知能力,MVPA 的改善效果好于 LPA;体力活动对老年人认知能力的影响存在性别差异,MVPA 每提高10min/day,男、 女认知能力得分分别提高约0.48分、0.71分,LPA 每提高10min/day,女性认知能力得分提高约 0.07分;MVPA 与老年人认知能力之间存在倒" U" 型剂量效应关系,21.13-34.49 min/day 的 MVPA 对老年人认知能力的改善效果最佳。

    Abstract

    Objective : This paper explores the dose-response relationship between physical activity and cognitive ability in the elderly based on objective measured physical activity. Methods :Actigraph GT3X+ is used to measure the physical activity of the elderly, and the cognitive ability of the elderly is evaluated by the Chinese version of the Simple Mental State Assessment Scale. The dose-response relationship between physical activity and cognitive ability of the elderly is analyzed by using a linear regression model.Results :Among 600 subjects, there are 512 (245 males and 267 females) complete and valid physical activity and cognitive ability test data. The results of linear regression analysis show that after adjusting for age,body mass index(BMI), highest education level and monthly average income, Moderate to Vigorous Physical Activity (MVPA) has a significant effect on the cognitive ability of the elderly (P＜0.01), and the improvement effect of MVPA is better in women than in men (standardized coefficient 0.693＞0.548). Light-intensity PA (LPA) only has significant effect on the cognitive ability of female elderly (P＜0.01). When MVPA is divided into four groups according to the quantile interval, it is found that there is an inverted “U” type dose-effect relationship between MVPA and cognitive ability of the elderly. Among the four models, the β coefficient of MVPA on cognitive ability in Q2 group (21.13 min/day≤MVPA＜34.49 min/day) is higher than that in the other three groups. No regular dose-response relationship is found between LPA and the elderly women. Conclusion : Physical activity can significantly improve the cognitive ability of the elderly, and the improvement effect of MVPA is better than LPA. The effect of physical activity on the cognitive ability of the elderly is different between men and women. The cognitive ability scores of men and women are increased by 0.48 and 0.71 points, respectively, when MVPA was increased by 10min/day, and the cognitive ability scores of women are increased by 0.07 points when LPA is increased by 10min/day. There is an inverted “U” type dose-effect relationship between MVPA and the cognitive ability of the elderly, and the MVPA with 21.13 min/day≤MVPA and 34.49 min/day has the best improvement effect on the cognitive ability of the elderly.

  • 人口老龄化是当前全球性问题,而我国尤为严重。随着人口老龄化进程不断推进,认知障碍和神经退行性疾病的发病率逐年升高[1]。流行病学研究报告显示,2015年全球痴呆患者4680万,到2050年将达到1.315亿,目前我国痴呆患者超过700万[2-3],痴呆症是老年人群中一种常见的神经退行性疾病,通常会导致独立性丧失、生活质量下降、过早死亡以及较高医疗保健费用等[4]。虽然在老龄化社区中,痴呆症已经是危害老年人生命质量的疾病之一,但是人们对能够减少其患病风险的因素关注相对较少。有研究发现,体力活动是预防认知障碍和痴呆症的保护性因素之一[5]。近年来,越来越多的研究证实, 体力活动能够预防认知能力下降、降低轻度认知障碍 (Mild Cognitive Impairment,MCI)发病率和延缓痴呆症的发生[6-7]。然而,国内外诸学者关于改善老年人认知能力的最佳体力活动剂量还没有定论[8-10],如中高强度体力活动 (Moderate to Vigorous Physical Activity,MVPA) 可以明显改善老年人的认知能力,但有人指出轻体力活动 (Light Physical Activity,LPA)对老年人认知能力具有独特的保护作用,MVPA与之无关。Zhu等人的研究发现, 老年人的MVPA%与认知功能之间存在剂量效应关系,较高的MVPA%与36%或更低的认知障碍风险相关[11]。此外,已有的研究大多数采用自我报告形式的体力活动数据,其可能受记忆偏差、健康状况、抑郁等因素影响,尤其是老年人对象[12]。为了克服自我报告形式的局限性,基于客观测量工具的体力活动数据正逐渐被采用,但仍相对较少,并且现有研究的样本规模相对较小[13]。鉴于此,本研究基于ActiGraph GT3X+和简易智力状态检查量表MMSE (Mini-mental State Examination)客观评定老年人的体力活动与认知能力,进而探究体力活动与我国老年人认知能力之间的剂量效应关系,以期丰富和完善运动认知领域相关的理论研究成果,并为延缓认知老化、预防痴呆症发生制定科学合理的体力活动干预方案提供参考依据。

  • 1 研究对象与方法

  • 1.1 研究对象

  • 采用多段分级抽样方法,根据南京市的地理位置特点,分别选择主城区鼓楼区、玄武区、秦淮区、建邺区及城郊的栖霞区共5个行政区,于2017年3月至2018年6月,共招募400名轻度认知障碍 (MMSE得分在10—23分)[14] 的老年人。纳入标准为:年龄 ≥60岁,精神状态、视力和听力允许完成认知量表测试,能正常沟通。排除标准为:已诊断患有阿尔兹海默症以及精神分裂症、严重抑郁症等精神疾病者;严重语言、视力和听力障碍者。所有受试者均签署知情同意书,研究过程中受试者如有不适可随时无条件退出。

  • 1.2 测试指标和方法

  • 1.2.1 受试者基本信息

  • 通过受试者填写调查问卷获取基本信息,主要包括年龄、身高、体重、BMI、最高学历、月平均收入等。

  • 1.2.2 体力活动水平测量

  • 采用三轴加速度计ActiGraph GT3X+测量老年人体力活动水平。测量时仪器置于右侧髂脊上部,连续佩戴7天,其中包括5个工作日和2个周末日,除洗澡、睡觉、游泳之外,其他时间都要佩戴。工作人员在7天测试结束之后的第8天回收仪器,并利用ActiLife (版本6.13.2)软件对数据进行处理。

  • 加速度计的各个体力活动测量参数设置,对于后期收集体力活动数据至关重要。通过分析和比较相关研究的老年人体力活动测量方法,从中选取了使用频率较高、较为合理的参数设置[15]。其中主要包括采样间隔、未佩戴时间定义、每天佩戴多少时间即为有效日、至少几天有效数据纳入统计分析、不同强度界值等,具体参数设置见表1。

  • 表1 加速度计的体力活动测量参数设置

  • 1.2.3 认知能力测试

  • 采用 《简易精神状态评价量表 (MMSE)》 中国版对老年人认知能力进行测试,该量表具有较好的信效度[16]。其中包括定向力、记忆力、注意力和计算力、回忆能力、语言能力等5个认知领域的测试。本量表的总分为30分,分数越高表明认知能力越好。

  • 1.3 数理统计法

  • 利用SPSS19.0软件对数据进行统计处理。符合正态分布的数据采用平均数 ± 标准差 (Mean±SD)进行描述,不符合正态分布的数据采用四分位间距进行描述。两组间比较,正态分布的数据采用t检验,非正态分布的数据采用Mann-Whitney检验。利用线性回归模型,探索体力活动与老年人认知能力之间的剂量效应关系。

  • 2 研究结果

  • 2.1 受试者基本信息

  • 在招募的400名社区老年人中,体力活动和认知能力测试数据均完整有效的共350名,其中男性168名,女性182名,受试者基本信息见表2。认知能力在男、女之间无显著差异 (P> 0.05)。平均每天LPA、MVPA的时间分别为168.53min、45.02min,女性平均每天LPA时间显著大于男性 (P<0.01),而MVPA时间无显著差异 (P>0.05)。

  • 表2 受试者基本信息表

  • 2.2 线性回归分析结果

  • 由表3可知,就总体而言,在未校正模型中,LPA、MVPA对老年人认知能力影响显著 (P<0.01),且该模型能解释老年人认知能力变异的56.4%;在模型2中,校正了年龄、BMI、最高学历、月平均收入因素后,LPA、MVPA仍对老年人认知能力产生显著影响 (P<0.01), 该模型能解释老年人认知能力变异的65.4%, LPA、MVPA对认知能力影响的β 系数分别为0.006、0.061 (标准化系数0.107、0.635,P< 0.01),即表示在一定范围内LPA、MVPA每增加10min/day,老年人认知能力表现分别增加0.06分 (95%CI:0.02—0.09)、0.61分 (95%CI:0.54—0.68),MVPA对老年人认知能力的改善效果好于LPA。

  • 在男性分析结果中,仅有MVPA对认知能力的影响显著 (P<0.01), 在校正模型中, MVPA对认知能力影响的β系数为0.048,即表示在一定范围内MVPA每增加10min/day,男性老年人认知能力得分增加约0.48分 (95%CI: 0.37—0.59)。在女性分析结果中,LPA、MVPA均对认知能力产生显著影响 (P<0.01),在校正模型中,LPA、MVPA对认知能力影响的 β系数分别为0.007、0.071,即表示在一定范围内LPA、MVPA每增加10min/day,女性老年人认知能力得分分别增加约0.07分 (95%CI: 0.03—0.11)、0.71分 (95%CI:0.62—0.80)。此外,由标准化回归系数可知,MVPA对女性老年人认知能力的改善效果好于男性 (0.693> 0.548)。

  • 表3 体力活动对认知能力影响的线性回归分析结果

  • 注:模型1未校正;模型2校正年龄、BMI、最高学历、月平均收入

  • 2.3 体力活动与老年人认知能力的剂量效应关系

  • 将所有受试对象MVPA的总体结果按照四分位数间距分成4组, 线性回归分析结果见表4。由图1可知,MVPA与老年人认知能力之间存在倒 “U”型剂量效应关系。在4个模型中,Q2组 (21.13min/day≤ MVPA< 34.49min/day) MVPA对认知能力影响的β 系数大于其他3组,这一结果表明,21.13-34.49min/day的MVPA对老年人认知能力的改善效果最佳。

  • 表4 MVPA对认知能力影响的β系数 (95%CI)

  • 注:*表示P<0.05,存在显著性差异;M1为未校正,M2为校正性别,M3为校正性别、年龄、BMI,M4为校正性别、年龄、 BMI、最高学历、月平均收入

  • 图1 MVPA与老年人认知能力的剂量效应关系

  • 3 讨论

  • 体力活动与老年人认知能力之间的联系已被诸多学者研究[17-18]。如一项前瞻性队列研究的meta分析结果表明,与低水平体力活动相比, 高水平的体力活动可以使痴呆症和阿尔茨海默症患病风险分别降低28%、45%,但其中纳入的16项研究均采用自我报告形式的体力活动数据[19]。自我报告不仅会受到老年人记忆、身体状况等因素的影响,使得研究结果存在一定的偏差,而且无法探讨LPA对认知能力的影响。为了克服自我报告形式的局限性,一些客观的测量方法逐渐被采用,本研究利用三轴加速度计来客观测量老年人的体力活动,消除了自我报告形式可能带来的潜在偏差。基于客观测量工具的一些研究也发现,活跃的老年人患认知障碍或痴呆症风险较低[20-21]。本研究结果显示,体力活动能显著改善老年人的认知能力,且存在性别差异, MVPA对女性的改善效果好于男性,LPA仅能显著改善女性老年人的认知能力;将MVPA按照四分位数间距分成4组发现,MVPA与老年人认知能力之间存在倒 “U”型剂量效应关系, 21.13—34.49min/day的MVPA对老年人认知能力的改善效果最佳。

  • MVPA可以明显改善老年人的认知能力[8,11],本研究与前人的研究结果一致。LPA对于老年人而言,是日常体力活动的主要部分, 是一种比较受欢迎、相对安全有效的活动形式[22]。目前,LPA对老年人认知能力的影响研究结果尚存在分歧。Kerr等通过对215名65岁以上老年人进行横断面研究发现,LPA与老年人认知能力之间不存在相关关系[23]。然而,Stubbs等选取274名老年人为研究对象,连续7天佩戴加速度计,并利用AD8量表评定其认知能力,结果表明,LPA是影响老年人认知能力的一个独立因素,对其具有独特的保护作用[24]。最近的一项研究也指出,LPA与老年人更好的认知能力有关[25]。我们同样得出了相似的结果, 就总体而言,LPA对老年人认知能力可产生显著影响。但值得注意的是,当进行男、女分层研究时发现,体力活动对老年人认知能力的影响存在性别差异,即MVPA对女性老年人认知能力的改善效果好于男性,LPA仅有益于女性老年人。一些证据表明,体力活动与老年人认知能力之间的关联性可能因性别而受到调节[26]。虽然目前尚不清楚体力活动对认知能力的影响存在性别差异的真正原因,但在分析已有研究之后认为,造成这种结果的原因可能有:①心肺耐力差异。一般情况下,与男性相比,女性的心肺耐力水平较低,因此可能对于体力活动的刺激更敏感,更容易产生积极的效果[27]。②生理反应差异。有研究指出,可能由于男、女之间下丘脑— 垂体—肾上腺轴系统和糖代谢对于体力活动引起的一系列反应存在差异导致[28]。③剂量效应关系。本研究数据显示,女性的LPA显著高于男性,体力活动对老年人认知能力的关联效应可能需要累积到一定的量。如Martinez等研究发现, 对认知任务的积极作用,仅出现在累积更多积极性通勤方式的女孩中[29]。

  • 流行病学研究表明,体力活动与认知能力之间存在一定的剂量效应关系。Zhu等通过对6452名老年人进行纵向研究指出,客观测量的MVPA%与老年人认知能力之间存在剂量效应关系,较高水平的MVPA%不仅有利于更好地维持老年人的记忆和执行功能,而且能够降低老年人认知障碍患病风险[31]。本研究发现,MVPA与老年人认知能力之间存在倒 “U”型剂量效应关系,与Paul等采用主观测量方法得到的研究结果一致[30]。此外, 本研究结果显示, 22.13—38.79min/day的MVPA对老年人认知能力的改善效果最佳,而根据国际体力活动指南推荐标准, 老年人每周至少需要150min的MVPA,本研究结果支持国际体力活动指南的推荐量。

  • 体力活动可能通过多种生理机制介导对老年人认知能力产生影响。首先,体力活动可以增强神经功能连通性[32]。并且,在动物实验中已被证实,体力活动能够通过促进神经传导、突触形成、血管再生和神经营养因子释放等机制介导对认知能力产生积极作用[33]。其次,体力活动能够增强大脑皮质可塑性,即体力活动可能有助于平衡衰老和神经退行性疾病对神经可塑性和功能的有害影响[34-35]。再次,LPA与较低水平的血浆炎症标志物c反应蛋白 (CRP) 有关[36]。 CRP是全身炎症的标志,这一发现表明,就认知健康而言,体力活动可能有利于消除系统性炎症诱发的负面后果。因此,炎症也被认为是影响体力活动和认知能力关系的一个因素。最后,有研究指出,步态速度与认知能力有关[37]。增加习惯性的活动与更快的步态速度有关[38]。更多的LPA可能代表更多的习惯性活动,而参与更多习惯性活动的个体可能有更快的步态速度和更好的认知能力,这或许可以解释LPA与认知能力之间的联系。值得一提的是,本研究发现, 21.13min/day≤ MVPA<34.49min/day对老年人认知能力的改善效果优于34.49min/day≤ MVPA<61.12min/day和MVPA≥61.12min/day,说明在改善老年人认知能力方面,MVPA并非越多越好。有研究表明,较高强度的体力活动能够增强机体氧化应激,对大脑功能产生负面影响[39]。因此,应根据老年人的身体特点,适当安排中高强度的体力活动来改善认知能力, 21.13—34.49min/day的MVPA这一剂量的体力活动可被推荐。

  • 本研究也存在一些局限,如加速度计无法捕获上肢运动,可能会低估MVPA时间;认知能力的评估单一以及横断面设计。因此,未来仍需要前瞻性和纵向实验性研究以进一步验证体力活动与老年人认知能力之间的因果关系。

  • 4 结论

  • (1)体力活动能显著改善轻度认知障碍老年人的认知能力,MVPA的改善效果好于LPA。

  • (2)体力活动对轻度认知障碍老年人认知能力的影响存在性别差异,MVPA每提高10min/day,男、女认知能力得分分别提高约0.48分、 0.71分;LPA每提高10min/day,女性认知能力得分提高约0.07分,男性无显著变化。

  • (3)MVPA与轻度认知障碍的老年人认知能力之间存在倒 “U” 型剂量效应关系,2 1.13—34.49min/day的MVPA对老年人认知能力的改善效果最佳。

  • 参考文献

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    • [26] LAURIN D,VERREAULT R,LINDSAY J,et al.Physical activity and risk of cognitive impairment and dementia in elderly persons[J].Archives of Neurology,2001,58(3):498.

    • [27] BARNES D E,YAFFE K,SATARIANO W A,et al.A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults[J].Journal of the American Geriatrics Society,2003,51(4):459.

    • [28] BAKER L D,FRANK L L,FOSTERSCHUBERT K,et al.Effects of aerobic exercise on mild cognitive impairment:a controlled trial[J].Archives of Neurology,2010,67(1):71.

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  • 基本信息

    中图分类号: G804.5
    文献标识码: A
    文章编号: 1008-3596(2022)02-0075-08

    基金信息

    江苏省社会科学基金项目 “江苏体医深度融合协同发展路径研究”(19TYB008)；

    引用信息

    稿件历史

    收稿日期: 2021-10-07

  • 参考文献

    • [1] GILL S J,FRIEDENREICH C M,SAJOBI T T,et al.Association between lifetime physical activity and cognitive functioning in middle-aged and older community dwelling adults:results from the brain in motion study[J].Journal of the International Neuropsychological Society,2015,21(10):816.

    • [2] World Alzheimer Report 2015.The Global Impact of Dementia[R/OL].[2020-04-08].https://www.alz.co.uk/research/World Alzheimer Report 2015.

    • [3] 中国老年医学学会认知障碍分会,认知障碍患者照料及管理专家共识撰写组.阿尔茨海默病患者日常生活能力和精神行为症状及认知功能全面管理中国专家共识(2019)[J].中华老年医学杂志,2020,39(1):1.

    • [4] FIEST K M,ROBERTS J I,MAXWELL C J,et al.The prevalence and incidence of dementia due to Alzheimer’s disease:a systematic review and meta-analysis[J].Canadian Journal of Neurological Sciences,2016,43(S1):S51.

    • [5] SOFI F,VALECCHI D,BACCI D,et al.Physical activity and risk of cognitive decline:a meta-analysis of prospective studies[J].Journal of Internal Medicine,2011,269(1):107.

    • [6] BLONDELL S J,HAMMERSLEYMATHER R,VEERMAN J L.Does physical activity prevent cognitive decline and dementia?:a systematic review and meta-analysis of longitudinal studies[J].Bmc Public Health,2014,14(1):510.

    • [7] PAILLARD T,ROLLAND Y,DE S B P.Protective effects of physical exercise in Alzheimer’s disease and parkinson’s disease:a narrative review[J].J Clinical Neurology,2015,11(3):212.

    • [8] ROSENBERG D E,BELLETTIERE J,GARDINER P A,et al.Independent associations between sedentary behaviors and mental,cognitive,physical,and functional health among older adults in retirement communities[J].Journals of Gerontology Series A:Biological Sciences and Medical Sciences,2016,71(1):78.

    • [9] WILBUR J E,MARQUEZ D X,FOGG L,et al.The relationship between physical activity and cognition in older Latinos[J].Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2012,67(5):525.

    • [10] JOHNSON L G,BUTSON M L,POLMAN R C,et al.Light physical activity is positively associated with cognitive performance in older community dwelling adults[J].Journal of Science and Medicine in Sport,2016,19(11):877.

    • [11] ZHU W F,HOWARD V J,WADLEY V G,et al.Association between objectively measured physical activity and cognitive function in older adults:the reasons for geographic and racial differences in stroke study[J].Journal of the American Geriatrics Society,2015,63(12):2447.

    • [12] SALLIS J F,SAELENS B E.Assessment of physical activity by self-report:status,limitations,and future directions[J].Research Quarterly for Exercise and Sport,2000,71(2):1.

    • [13] TROIANO R P,BERRIGAN D,DODD K W,et al.Physical activity in the United States measured by accelerometer[J].Medicine and Science in Sports and Exercise,2008,40(1):181.

    • [14] 陆杰华,李月.中国大陆轻度认知障碍老人死亡风险的影响因素研究[J].人口学刊,2015,37(5):94.

    • [15] GORMAN E,HANSON H M,YANG P H,et al.Accelerometry analysis of physical activity and sedentary behavior in older adults:a systematic review and data analysis[J].European Review of Aging and Physical Activity,2014,11(1):35.

    • [16] 王云辉,范宏振,谭淑平,等.社区老年人身体活动与认知功能的关系[J].中国心理卫生杂志,2016,30(12):909.

    • [17] GEDA Y E,ROBERTS R O,KNOPMAN D S,et al.Physical exercise and mild cognitive impairment:a population-based study[J].Arch Neurol,2010,37(1):80.

    • [18] WILLEY J Z,GARDENER H,CAUNCA M R,et al.Leisure-time physical activity associates with cognitive decline:the northern Manhattan study[J].Neurology,2016,86(20):1897.

    • [19] HAMER M,CHIDA Y.Physical activity and risk of neurodegenerative disease:a systematic review of prospective evidence[J].Psychological medicine,2009,39(1):3.

    • [20] BUCHMAN A S,BOYLE P A,YU L,et al.Total daily physical activity and the risk of AD and cognitive decline in older adults[J].Neurology,2012,78(17):1323.

    • [21] BARNES D E,BLACKWELL T,STONE K L,et al.Cognition in older women:the importance of daytime movement[J].Journal of the American Geriatrics Society,2008,56(9):1658.

    • [22] ANDY C Y,WONG T W L,LEE P H.Effect of low-intensity exercise on physical and cognitive health in older adults:a systematic review[J].Sports Medicine-Open,2015,1(1):1.

    • [23] KERR J,MARSHALL S J,PATTERSON R E,et al.Objectively measured physical activity is related to cognitive function in older adults[J].Journal of the American Geriatrics Society,2013,61(11):1927.

    • [24] STUBBS B,CHEN L J,CHANG C Y,et al.Accelerometer-assessed light physical activity is protective of future cognitive ability:a longitudinal study among community dwelling older adults[J].Experimental Gerontology,2017,91:104.

    • [25] UMEGAKI H,MAKINO T,UEMURA K,et al.Objectively measured physical activity and cognitive function in urban-dwelling older adults[J].Geriatrics & Gerontology International,2018,18(6):922.

    • [26] LAURIN D,VERREAULT R,LINDSAY J,et al.Physical activity and risk of cognitive impairment and dementia in elderly persons[J].Archives of Neurology,2001,58(3):498.

    • [27] BARNES D E,YAFFE K,SATARIANO W A,et al.A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults[J].Journal of the American Geriatrics Society,2003,51(4):459.

    • [28] BAKER L D,FRANK L L,FOSTERSCHUBERT K,et al.Effects of aerobic exercise on mild cognitive impairment:a controlled trial[J].Archives of Neurology,2010,67(1):71.

    • [29] MARTÍNEZ-GÓMEZ D,RUIZ J R,GÓMEZ-MARTÍNEZ S,et al.Active commuting to school and cognitive performance in adolescents:the AVENA study[J].Archives of Pediatrics & Adolescent Medicine,2011,165(4):300.

    • [30] ZHU W F,WADLEY V G,HOWARD V J,et al.Objectively measured physical activity and cognitive function in older adults[J].Medicine and Science in Sports and Exercise,2017,49(1):47.

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