This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures.

BACKGROUND:Knee osteoarthritis is considered as one of the most prevalent musculoskeletal disorders which leads to joint degeneration and consequently disability in activities of daily living. This study aimed to evaluate the effects of aromatherapy massage with lavender essence on activities of daily living of patients with knee osteoarthritis.

METHODS:This is a single-blinded, randomized clinical trial. A total of 90 patients with osteoarthritis of the knee referring to the outpatient rheumatology clinics affiliated to Birjand University of Medical Sciences were selected via convenience sampling method. The participants were randomly assigned into three groups: intervention group (aromatherapy massage with lavender essential oil), placebo group (massage with almond oil) and control group (without massage). The activities of daily living of patients was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at baseline, immediately after the intervention, 1 week, and 4 weeks after the intervention. Data were analyzed using SPSS statistical software version 16.

RESULTS:The activities of daily living of patients were significantly improved immediately and 1 week after the intervention in the intervention group compared with their initial status (p < .001) and that of the control group (p < .001 and p = .03 respectively). However, 4 weeks after the intervention, there was no significant difference between the groups according to the Western Ontario and McMaster Universities Osteoarthritis index (p = .95).

CONCLUSION:Aromatherapy massage with lavender essential oil may reduce the incidence of activities of daily living disability in patients with osteoarthritis of the knee. However, further studies are required to confirm findings of this study.

EEG activity, alertness, and mood were assessed in 40 adults given 3 minutes of aromatherapy using two aromas, lavender (considered a relaxing odor) or rosemary (considered a stimulating odor). Participants were also given simple math computations before and after the therapy. The lavender group showed increased beta power, suggesting increased drowsiness, they had less depressed mood (POMS) and reported feeling more relaxed and performed the math computations faster and more accurately following aromatherapy. The rosemary group, on the other hand, showed decreased frontal alpha and beta power, suggesting increased alertness. They also had lower state anxiety scores, reported feeling more relaxed and alert and they were only faster, not more accurate, at completing the math computations after the aromatherapy session.

Background This randomized, blinded, placebo-controlled clinical trial identifies the effect of an aromatherapy blend of essential oils on fatigue, which is one of the most commonly unaddressed symptoms of hypothyroidism, by evaluating the effects of daily aromatherapy inhalation. Methods Participants included women aged 18-55 with a diagnosis of hypothyroidism. Women who had a history of thyroid cancer were excluded, due to the confounding effects of cancer on fatigue as the outcome of interest. Participants were randomized into two groups: the aromatherapy group, treated with inhalation of the essential oil blend, and the control group, treated with an odorless vegetable oil blend. The primary outcome was change from baseline in fatigue scores as measured by the Multidimensional Fatigue Symptom Inventory (MFSI), a validated instrument which measures multiple patterns of fatigue. Results After adjusting for baseline scores, no significant difference was found between the aromatherapy group and the control group at midpoint. Both groups experienced a reduction in symptoms during the first week of the intervention. At the endpoint, participants in the aromatherapy group had improved fatigue scores across all ten subscales, as compared to the control group. Not all improvements achieved statistical significance, indicating that the aromatherapy treatment has a greater effect on the subscales of global, affective, and general fatigue. Conclusions This is the first study to evaluate the effects of aromatherapy on fatigue among women with hypothyroidism. These findings provide evidence that regular inhalation of an aromatherapy blend may reduce fatigue among women with hypothyroidism, particularly in the areas of global, affective, and general fatigue.

In the present study, we examined whether particular urinary oxylipins (isoprostanes (IsoPs), leukotrienes (LTs), prostaglandins (PGs), and thromboxanes (TXs)) in 16 elite triathletes could alter during 145 days of training. Within this time span, 45 days were dedicated to examining the effects of the intake of a beverage rich in polyphenols (one serving: 200 mL per day) supplemented in their diet. The beverage was a mixture of citrus juice (95%) and Aronia melanocarpa juice (5%) (ACJ). Fifty-two oxylipins were analyzed in the urine. The quantification was carried out using solid-phase extraction, liquid chromatography coupled with triple quadrupole mass spectrometry. The physical activity decreased the excretion of some PG, IsoP, TX, and LT metabolites from arachidonic acid,γ-dihomo-linolenic acid, and eicosapentaenoic acid. The ACJ also reduced the excretion of 2,3-dinor-11β-PGFand 11-dehydro-TXB, although the levels of other metabolites increased after juice supplementation (PGE, 15-keto-15-F-IsoP, 20-OH-PGE, LTE, and 15-epi-15-E-IsoP), compared to the placebo. The metabolites that increased in abundance have been related to vascular homeostasis and smooth muscle function, suggesting a positive effect on the cardiovascular system. In conclusion, exercise influences mainly the decrease in oxidative stress and the inflammation status in elite triathletes, while ACJ supplementation has a potential benefit regarding the cardiovascular system that is connected in a synergistic manner with elite physical activity.

The aim of the present study was to determine changes occurring in the erythrocyte concentrations of arsenic (As), cadmium (Cd) and lead (Pb) in highly trained males, moderately trained males and sedentary men living in the same area of Extremadura (Spain). Thirty sedentary subjects (24.34 ± 3.02 years) with no sports practice and a less active lifestyle formed the control group (CG). Twenty-four moderately trained subjects (23.53 ± 1.85 years), who practised sports at a moderate level between 4 and 7 h/week, without any performance objective and without following any type of systematic training, formed the group of subjects with a moderate degree of training (MTG). And 22 professional cyclists (23.29 ± 2.73 years) at the beginning of their sports season, who trained for more than 20 h/week formed the high-level training group (HTG). Erythrocyte samples fromall subjects in a fasting stage were collected, washed and frozen at -80 °C until analysis. Erythrocyte analysis of the trace elements As, Cd and Pb was performed by inductively coupled plasma mass spectrometry (ICP-MS). As concentration was lower in CG (p < 0.01) and MTG (p < 0.01) than HTG. Cd (p < 0.001) and Pb (p < 0.05) concentrations were higher in CG than HTG. All results were expressed in μg/g Hb. Physical training produces a decrease in erythrocyte concentrations of Cd and Pb, as an adaptation in order to avoid their accumulation in the cells and preserve correct cellular functioning. The higher As concentration should be investigated in high-level sportsmen because of a possible negative effect on the cells.

INTRODUCTION:Cancer patients are particularly vulnerable to depression and anxiety, with fatigue as the most prevalent symptom of those undergoing treatment. The purpose of this study was to determine whether improvement in depression, anxiety or fatigue during chemotherapy following anthroposophy art therapy intervention is substantial enough to warrant a controlled trial.

MATERIAL AND METHODS:Sixty cancer patients on chemotherapy and willing to participate in once-weekly art therapy sessions (painting with water-based paints) were accrued for the study. Nineteen patients who participated in>or =4 sessions were evaluated as the intervention group, and 41 patients who participated in

RESULTS:BFI scores were higher in the participant group (p=0.06). In the intervention group, the median HADS score for depression was 9 at the beginning and 7 after the fourth appointment (p=0.021). The median BFI score changed from 5.7 to 4.1 (p=0.24). The anxiety score was in the normal range from the beginning.

CONCLUSION:Anthroposophical art therapy is worthy of further study in the treatment of cancer patients with depression or fatigue during chemotherapy treatment.

BACKGROUND:Mild cognitive impairment (MCI) is a phase in cognitive decline when it is still possible to intervene to reverse the decline. Cognitive stimulation delivered through psychosocial interventions provides both psychological intervention and social stimulation to improve cognition. A pilot open-label parallel-arms randomized controlled trial was undertaken to examine the effects of art therapy (AT) and music reminiscence activity (MRA) compared to the control, on the primary outcome of neurocognitive domain assessments in elderly people with MCI.

METHODS:Community-living elderly people with MCI (Petersen's criteria), assessed for study eligibility, were randomized using a web-based system with equal allocation to two intervention arms: AT (guided viewing of art pieces and production of visual arts) and MRA (listening, and recalling memories related to music) and a control arm (standard care without any intervention). Interventions were led by trained therapists weekly for 3 months, then fortnightly for 6 months. Neurocognitive domains (mean of memory, attention, and visuo-spatial abilities standardized scores), psychological wellbeing (subsyndromal depression and anxiety) and telomere length as a biological marker of cellular ageing, were assessed by intervention-blinded assessors at baseline, 3 months and 9 months.

RESULTS:In total, 250 people were screened and 68 were randomized and included in the analysis. In the AT arm, neurocognitive domains improved compared to the control arm at 3 months (mean difference (d) = 0.40; 90% CI 0.126, 0.679) and were sustained at 9 months (d = 0.31; 90% CI 0.068, 0.548). There wassome improvement in depression and anxiety at 3 and 9 months and in telomere length at 9 months, but this was not significant. Similar improvements were observed in the MRA arm over the control arm, but they were not significant. There were no intervention-related adverse effects.

CONCLUSIONS:Art therapy delivered by trained staff as"art as therapy"and"art psychotherapy"may have been the significant contributor to cognitive improvements. The findings support cognitive stimulation for elderly people with cognitive decline and signal the need for larger studies and further investigation of carefully designed psycho-social interventions for this group.

TRIAL REGISTRATION:Clinical Trials.gov, NCT02854085 . Registered on 7 July 2016.

Background:The purpose of this study was to determine the effect of blueberry supplementation on exercise performance time, inflammation markers, energy substrates, insulin, and TAS levels during two periods: non-supplemented period and supplemented period.

Methods:Eight young active participants were recruited from the Department of Physical Education at some universities in Busan City, Republic of Korea. The test period was divided into two Sections: non-supplemented period and supplemented period. Vo2 max and exercise performance time of participants were measured, with or without blueberry supplementation, with a portable gas analyzer and ECG, respectively.

Results:Vo2 max and exercise performance time were increased in the blueberry supplementation period. IL-6 and CRP levels were significantly lowered in blueberry supplementation period following exercise.

Conclusion:The blueberry supplementation can potentially increase the exercise performance and decrease the IL-6 and CRP levels caused by an increased TAS level.

OBJECTIVE: To assess dietary compliance to Gluten Free Diet (GFD), to identify barriers to compliance and to study the impact of diet on the psychosocial behavior of children with celiac disease.

METHODS: Children diagnosed with celiac disease and followed up for more than 6 months, were assessed for dietary compliance. After this assessment, patients were subjected to an interview, consisting of self administered questionnaire, by the investigator who was blinded to initial results of initial assessment. Psychosocial parameters were assessed by standard Pediatric Symptom Checklist (PSC) containing 35 items. Dietary compliant and non-compliant groups were compared for assessed factors affecting the dietary compliance. Cases were also compared to healthy controls for psychosocial parameters.

RESULTS: A total of 70 patients were assessed for dietary compliance: 53(75%) were found to be dietary compliant, 13(18%) dietary non-compliant while 4 had doubtful dietary compliance. Final analysis was done for 64 patients who had complete assessment; 4 patients with doubtful dietary compliance and 2 patients who had incomplete assessment, were excluded. Dietary compliance was higher in younger children (>80%) compared to adolescents (44%); in children with higher maternal education; in parents having better knowledge and understanding of disease. Compliance was better in nuclear families; with less number of siblings (68.3% of compliant had<2 siblings compared to 23% in non-compliant); in families with higher per capita income. Dietary compliance was also better in children who presented with typical symptoms of celiac disease (72% of dietary compliant presented with loose motion as presenting symptom compared to only 15% in non-compliant). Celiac children had problems related to adjustment such as difficulty in maintaining diet at school, restaurants, trips, etc.45% patients complained that their teachers don't understand the nature of their disease. Pediatric Symptom Checklist (PSC) score was above cut-off in 4 children of dietary non-compliant group. Few individual PSC items such as complaints of aches and pains; is irritable, angry; does not listen to the rules, blames other for mistakes; teases others; refuses to share, were more common in celiac children than control.

CONCLUSIONS: Noncompliance to gluten free dietary regimen is seen in 18 % of cases. Dietary noncompliance is more common in the adolescent age group, in joint families and those who have more number of siblings. Dietary restrictions have impact on child's social activities and thus psychosocial parameters (PSC score) are better in the dietary compliant group.

Qigong is an ancient form of health maintenance, which is part of Traditional China Medicine. Numerous beneficial mental and physical effects have been classically ascribed to this traditional psychosomatic method. The purpose of this work has been to assess the effects of Taoist qigong practice on several hormonal parameters of the Hipotalamic-Pituitary-Adrenal axis and specific measures of psychological well-being in healthy subjects. Forty-three healthy volunteers participated in the study, of whom 22 were randomly allocated to the experimental group, and 21 were assigned to the control group. Experimental participants underwent a qigong training program for one month. Blood samples for the quantification of hormonal parameters, and several instruments to assess anxiety and depression symptoms as well as subjective sleep quality, were obtained before and after the program. Statistically significant differences were found between the experimental and control groups, with the experimental group showing lower blood levels of adrenocorticotropic hormone (ACTH). This study shows that Taoist qigong is a psychosomatic method able to exert a modulatory action on ACTH levels in healthy subjects. We consider the need to continue exploring the psychobiological modulation of this qigong method and its possible repercussion for human health care.

BACKGROUND:This study was aimed at investigating the impact of assisted cycling therapy (ACT) on fine manual dexterity in adults with Down's syndrome (DS).

METHODS:Nine persons with DS completed four different interventions: voluntary exercise (VE), voluntary with music (VEM), assisted exercise (AE) and no exercise (NE). Fine manual dexterity (e.g., Purdue Pegboard) was tested pre and post interventions.

RESULTS:The results showed dominant and bimanual hands were improved after AE but no evident in either subtest after VE. The assembly subtest, processed by spatial-temporal ability, was only improved after VEM and NE.

CONCLUSIONS:It is speculated that AE stimulated more peripheral sensory input to the motor cortex and neurotransmitters than the other interventions. In addition, the involvement of music may enhance spatial intelligence during VEM. Even though the exact mechanisms are still unknown, the implication of our results showed that AE and VEM can improve fine manual dexterity in persons with DS.

BACKGROUND: Thus far, few factors with a causal relation to preterm birth have been identified. Many studies have focused on the woman's diet, but most have been discouraging. The aim of the present study was to examine if maternal intake of a Mediterranean-type diet (MD) is associated with reduced risk of preterm birth.

METHODS: The Danish National Birth Cohort assessed diet in mid-pregnancy by food frequency questionnaires (FFQ). Women consuming MD were those who ate fish twice a week or more, used olive or rape seed oil, consumed 5+ fruits and vegetables a day, ate meat (other than poultry and fish) at most twice a week, and drank at most 2 cups of coffee a day.

RESULTS: Of 35,530 non-smoking women, 1,137 (3.2%) fulfilled all MD criteria, and 540 (1.5%) none. Odds ratios for preterm birth and early preterm birth were 0.61 (95% Confidence Interval (CI): 0.35-1.05) and 0.28 (0.11-0.76), respectively, in MD women compared to women fulfilling none of the MD criteria.

CONCLUSION: Shifting towards a MD during pregnancy may reduce the risk of early delivery in Danish women.

 To investigate the association between active commuting and incident cardiovascular disease (CVD), cancer, and all cause mortality. Prospective population based study. UK Biobank. 263 450 participants (106 674 (52%) women; mean age 52.6), recruited from 22 sites across the UK. The exposure variable was the mode of transport used (walking, cycling, mixed modenon-active (car or public transport)) to commute to and from work on a typical day. Incident (fatal and non-fatal) CVD and cancer, and deaths from CVD, cancer, or any causes. 2430 participants died (496 were related to CVD and 1126 to cancer) over a median of 5.0 years (interquartile range 4.3-5.5) follow-up. There were 3748 cancer and 1110 CVD events. In maximally adjusted models, commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality (cycling hazard ratio 0.59, 95% confidence interval 0.42 to 0.83, P=0.002; mixed mode cycling 0.76, 0.58 to 1.00, P<0.05), cancer incidence (cycling 0.55, 0.44 to 0.69, P<0.001; mixed mode cycling 0.64, 0.45 to 0.91, P=0.01), and cancer mortality (cycling 0.60, 0.40 to 0.90, P=0.01; mixed mode cycling 0.68, 0.57 to 0.81, P<0.001). Commuting by cycling and walking were associated with a lower risk of CVD incidence (cycling 0.54, 0.33 to 0.88, P=0.01; walking 0.73, 0.54 to 0.99, P=0.04) and CVD mortality (cycling 0.48, 0.25 to 0.92, P=0.03; walking 0.64, 0.45 to 0.91, P=0.01). No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes. Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes. Cycle commuting was associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden ofimportant chronic conditions.

Background Active commuting is related to a higher level of physical activity but more exposure to ambient air pollutants. With the rather serious air pollution in urban China, we aimed to examine the association between active commuting and risk of incident cardiovascular disease in the Chinese population.

Methods and Results A total of 104 170 urban commuters without major chronic diseases at baseline were included from China Kadoorie Biobank. Self-reported commuting mode was defined as nonactive commuting, work at home or near home, walking, and cycling. Multivariable Cox regression was used to examine associations between commuting mode and cardiovascular disease. Overall, 47.2% of the participants reported nonactive commuting, 13.4% reported work at home or work near home, 20.1% reported walking, and 19.4% reported cycling. During a median follow-up of 10 years, we identified 5374 incidents of ischemic heart disease, 664 events of hemorrhagic stroke, and 4834 events of ischemic stroke. After adjusting for sex, socioeconomic status, lifestyle factors, sedentary time, body mass index, comorbidities, household air pollution, passive smoking, and other domain physical activity, walking (hazard ratio, 0.90; 95% CI, 0.84-0.96) and cycling (hazard ratio, 0.81; 95% CI, 0.74-0.88) were associated with a lower risk of ischemic heart disease than nonactive commuting. Cycling was associated with a lower risk of ischemic stroke (hazard ratio, 0.92; 95% CI, 0.84-1.00). No significant association was found of walking or cycling with hemorrhagic stroke. The associations of commuting mode with major cardiovascular disease were consistent among men and women and across different levels of other domain physical activity.

Conclusions In urban China, cycling was associated with a lower risk of ischemic heart disease and ischemic stroke. Walking was associated with a lower risk of ischemic heart disease.

BACKGROUND:Being breastfed in infancy has been shown to benefit neurodevelopment. However, whether the benefits persist to old age remains unclear.

METHODS:We examined the associations between breastfeeding and its duration on cognitive ability in young adulthood and old age, and on aging-related cognitive change over five decades. In total, 931 men from the Helsinki Birth Cohort Study born in 1934-1944 in Finland took the Finnish Defence Forces Basic Intellectual Ability Test (total and verbal, arithmetic and visuospatial subtest scores) twice, at ages 20.2 and 67.9 years, and had data on breastfeeding (yes v. no) and its duration ('never breastfed', 'up to 3', '3 to 6' and '6 or more months'). Linear and mixed model regressions tested the associations.

RESULTS:At 20.2 years, breastfed men had higher cognitive ability total and visuospatial subtest scores [mean differences (MDs) ranged between 3.0-3.9, p values<0.013], and its longer duration predicted higher cognitive ability total and arithmetic and visuospatial subtest scores (MDs ranged between 3.0 and 4.8, p values<0.039). At 67.9 years, breastfed men had higher total cognitive ability and all subtest scores (MDs ranged between 2.6 and 3.4, p values<0.044) and its longer duration predicted all cognitive ability scores (MDs ranged between 3.1 and 4.7, p values<0.050). Verbal subtest scores decreased over five decades in men who were never breastfed or were breastfed for 3 months or less, and increased in those breastfed for longer than 3 months.

CONCLUSIONS:Neurodevelopmental advantages of breastfeeding and its longer duration persist into old age, and longer duration of breastfeeding may benefit aging-related change, particularly in verbal reasoning ability.

INTRODUCTION:yerba mate is a traditional drink consumed in South America, produced from toasted leaves of Ilex paraguariensis. Several studies have demonstrated its lipid-lowering properties due to the presence of polyphenols and saponins.

OBJECTIVE:to analyze the effect of daily yerba mate consumption on the values of serum lipids and body composition in overweight women.

METHODS:119 overweight women between 25 and 50 years were divided into three groups: Mate and Diet (MD), Mate without Diet (M), and Water and Diet (AD). For 12 weeks the M and MD groups were supplemented with mate, while the AD and MD groups maintained a hypocaloric food plan. Anthropometric measurements and blood tests (total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) were taken at the beginning and at the end of the study. The statistical analysis was performed using Student's t-test or Wilcoxon's test for paired samples and ANOVA (p<0.05 was considered significant in all cases).

RESULTS:total cholesterol decreased in all groups (10.21 mg/dL in MD, 18.29 mg/dL in M, and 17.63 mg/dL in AD, without differences between groups). LDL-cholesterol decreased in both groups with mate (8.07 mg/dL in MD, 16.04 mg/dL in M, without differences between groups) while HDL-cholesterol decreased in M (2.09 mg/dL). On the other hand, triglycerides fell 10.74 mg/dL in the MD group.

CONCLUSIONS:a daily intake of mate helps reduce total cholesterol and LDL-cholesterol, and provides a reduction of triglycerides along with a low-calorie diet.

BACKGROUND:This study aimed to evaluate the association of the lifelong duration of breast feeding with metabolic syndrome (MetS) and its components in Korean parous women aged 19-50 years.

MATERIALS AND METHODS:A total of 4724 participants from the Korean National Health and Nutritional Survey were included. Subjects were divided into four groups according to the duration of breast feeding:≤5, 6-11, 12-23, or ≥24 months groups. The adjusted odds ratios (ORs) of MetS and its components were assessed according to the duration of breast feeding.

RESULTS:Women who breastfed for 6-11 months had an OR of 0.67 (95% confidence interval [CI], 0.54-0.86) for elevated blood pressure (BP) compared with those who breastfed for≤5 months after adjustment for possible confounders in a multivariable logistic regression analyses. Women who breastfed for 12-23 months were associated with an OR of 0.68 (95% CI, 0.54-0.86) for elevated BP, an OR of 0.78 (95% CI, 0.62-0.97) for elevated glucose, and an OR of 0.73 (95% CI, 0.56-0.95) for MetS compared with those who breastfed for ≤5 months in a multivariable logistic regression analyses. Women who breastfed for ≥24 months had an OR of 0.62 (95% CI, 0.52-0.84) for elevated glucose, an OR of 0.76 (95% CI, 0.60-0.96) for elevated triglycerides, and an OR of 0.70 (95% CI,0.53-0.92) for MetS compared with those who breastfed for ≤5 months in a multivariable logistic regression analyses.

CONCLUSIONS:Our results suggest that lifelong breast feeding for≥12 months may be associated with lower risk for MetS.

OBJECTIVE:This study was conducted to examine the causal association between exercise and the risk of dementia among older Chinese adults.

DESIGN:Longitudinal population-based study with a follow-up duration of 9 years.

SETTING:Data for the Chinese Longitudinal Healthy Longevity Survey waves occurring from 2002 to 2011-2012 were extracted from the survey database.

PARTICIPANTS:In total, 7501 dementia-free subjects who were older than 65 years were included at baseline. Dementia was defined as a self-reported or proxy-reported physician's diagnosis of the disease.

OUTCOME MEASURES AND METHODS:Regular exercise and potential confounding variables were obtained via a self-report questionnaire. We generated longitudinal logistic regression models based on time-lagged generalised estimating equation to examine the causal association between exercise and dementia risk.

RESULTS:Of the 7501 older Chinese people included in this study, 338 developed dementia during the 9-year follow-up period after excluding those who were lost to follow-up or deceased. People who regularly exercised had lower odds of developing dementia (OR=0.53, 95% CI 0.33 to 0.85) than those who did not exercise regularly.

CONCLUSION:Regular exercise was associated with decreased risk of dementia. Policy-makers should develop effective public health programmes and build exercise-friendly environments for the general public.

OBJECTIVE:To address the association between exercise capacity and the onset of dementia, Alzheimer disease, and cognitive impairment.

PATIENTS AND METHODS:For 6104 consecutive veteran patients (mean± SD age: 59.2±11.4 years) referred for treadmill exercise testing, the combined end point of dementia, Alzheimer disease, and cognitive impairment was abstracted from the Veterans Affairs computerized patient record system.

RESULTS:After mean± SD follow-up of 10.3±5.5 years, 353 patients (5.8%) developed the composite end point at a mean ± SD age of 76.7±10.3 years. After correction for confounders in multivariate Cox proportional hazards regression, higher age at exercise testing (hazard ratio [HR]=1.08; 95% CI, 1.07-1.09; P<.001), current smoking (HR=1.44; 95% CI, 1.08-1.93; P=.01), and exercise capacity (HR=0.92; 95% CI, 0.89-0.96; P<.001) emerged as predictors of cognitive impairment. Each 1-metabolic equivalent increase in exercise capacity conferred a nearly 8% reduction in the incidence of cognitive impairment. Meeting the recommendations for daily activity was not associated with a delay in onset of cognitive impairment (HR=1.07; 95% CI, 0.86-1.32; P=.55).

CONCLUSION:Exercise capacity is strongly associated with cognitive function; the inverse association between fitness and cognitive impairment provides an additional impetus for health care providers to promote physical activity.