Annals of Behavioral Medicine

, Volume 50, Issue 3, pp 397–408 | Cite as

Body Mass and Physical Activity Uniquely Predict Change in Cognition for Aging Adults

  • Molly Memel
  • Kyle Bourassa
  • Cindy Woolverton
  • David A. Sbarra
Original Article



Physical activity and body mass predict cognition in the elderly. However, mixed evidence suggests that obesity is associated with poorer cognition, while also protecting against cognitive decline in older age.


We investigated whether body mass independently predicted cognition in older age and whether these associations changed over time.


A latent curve structural equation modeling approach was used to analyze data from a sample of aging adults (N = 8442) split into two independent subsamples, collected over 6 years.


Lower baseline Body Mass Index (BMI) and higher physical activity independently predicted greater baseline cognition (p < 0.001). Decreases in BMI and physical activity independently predicted greater decline in the slope of cognition (p < 0.001).


Our results support the obesity paradox in cognitive aging, with lower baseline body mass predicting better cognition, but less decline over time protecting against cognitive decline. We discuss how weight loss in the elderly may serve as a useful indicator of co-occurring cognitive decline, and we discuss implications for health care professionals.


Cognitive aging Physical activity Body mass 


Compliance with Ethical Standards

Conflicts of Interest

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards Authors Molly Memel, Kyle Bourassa, Cindy Woolverton, and David A. Sbarra declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Funding Source

This paper uses data from SHARE wave 4 release 1.1.1, as of March 28th 2013, and SHARE wave 1 and 2 release 2.6.0 as of November 29th 2013. The SHARE data collection has been primarily funded by the European Commission through the 5th Framework Programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life), through the 6th Framework Programme (projects SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5-CT-2005-028857, and SHARELIFE CIT4-CT-2006-028812), and through the 7th Framework Programme (SHARE-PREP, N° 211909, SHARE-LEAP, N° 227822 and SHARE M4, N° 261982). Additional funding from the U.S. National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11 and OGHA 04–064) and the German Ministry of Education and Research as well as from various national resources is gratefully acknowledged (see for a full list of funding institutions).

Informed Consent

Until July 2011, SHARE has been reviewed and approved by the Ethics Committee of the University of Mannheim. Since then, the Ethics Council of the Max-Planck-Society for the Advancement of Science (MPG) is responsible for ethical reviews and the approval of the study.


  1. 1.
    10 facts on ageing and the life course. World Health Organization Website. Reviewed October 2014. Accessed April 5, 2015.
  2. 2.
    Bherer L, Erickson KI, Liu-Ambrose T. A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. J Aging Res. 2013; 2013: 657508.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Chan JSY, Yan JH, Payne VG. The impact of obesity and exercise on cognitive aging. Front Aging Neurosci. 2013; 5: 97.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chapman SB, Aslan S, Spence JS, et al. Shorter term aerobic exercise improves brain, cognition, and cardiovascular fitness in aging. Front Aging Neurosci. 2013; 5: 75.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Pereira AC, Huddleston DE, Brickman AM, et al. An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proc Natl Acad Sci U S A. 2007; 104(13): 5638-5643.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Muller S, Scharhag J. The intensity and effects of strength training in the elderly. Dtsch Ärztebl Int. 2011; 108(21): 359-364.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Tsai CL, Wang CH, Pan CY, Chen FC. The effects of long-term resistance exercise on the relationship between neurocognitive performance and GH, IGF-1, and homocysteine levels in the elderly. Front Behav Neurosci. 2015; 9: 23.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Cassilhas RC, Viana VA, Grassmann V, et al. The impact of resistance exercise on the cognitive function of the elderly. Med Sci Sports Exerc. 2007; 39: 1401-1407.CrossRefPubMedGoogle Scholar
  9. 9.
    Bolandzadeh N, Tam R, Handy TC, et al. Resistance training and white matter lesion progression in older women: Exploratory analysis of a 12-month randomized controlled trial. J Am Geriatr Soc. 2015; 63(10): 2052-2060.CrossRefPubMedGoogle Scholar
  10. 10.
    Elias I, Franckhauser S, Ferré T, et al. Adipose tissue overexpression of vascular endothelial growth factor protects against diet-induced obesity and insulin resistance. Diabetes. 2012; 61(7): 1801-1813.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996; 334(5): 292-295.CrossRefPubMedGoogle Scholar
  12. 12.
    Greenwood CE, Winocur G. High-fat diets, insulin resistance and declining cognitive function. Neurobiol Aging. 2005; 26(Suppl 1): 42-45.Google Scholar
  13. 13.
    Jakicic JM. The effect of physical activity on body weight. Obesity (Silver Spring). 2009; 17(Suppl 3): S34-S38.CrossRefGoogle Scholar
  14. 14.
    Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007; 39(8): 1435-1445.CrossRefPubMedGoogle Scholar
  15. 15.
    Sundquist J, Johansson S-E. The influence of socioeconomic status, ethnicity and lifestyle on body mass index in a longitudinal study. Int J Epidemiol. 1998; 27(1): 57-63.CrossRefPubMedGoogle Scholar
  16. 16.
    Aichberger MC, Busch MA, Reischies FM, Ströhle A, Heinz A, Rapp MA. Effect of physical inactivity on cognitive performance after 2.5 years of follow-up. GeroPsych J Gerontopsychol Geriatr Psychiatr. 2010; 23(1): 7-15.Google Scholar
  17. 17.
    Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004; 101(9): 3316-3321.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011; 108(7): 3017-3022.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychol Sci. 2003; 14(2):125-30.Google Scholar
  20. 20.
    Stern Y. Cognitive reserve. Neuropsychologia. 2009; 47(10): 2015-2028.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Barnes DE, Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003; 51(4): 459-465.CrossRefPubMedGoogle Scholar
  22. 22.
    Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol A Biol Sci Med Sci. 2006;61(11):1166–1170.Google Scholar
  23. 23.
    Ruitenberg A, den Heijer T, Bakker SLM, et al. Cerebral hypoperfusion and clinical onset of dementia: The Rotterdam study. Ann Neurol. 2005; 57(6): 789-794.CrossRefPubMedGoogle Scholar
  24. 24.
    Aagaard P, Suetta C, Caserotti P, et al. Role of the nervous system in sarcopenia and muscle atrophy with aging: Strength training as a countermeasure. Scand J Med Sci Sports. 2010; 20: 49-64.CrossRefPubMedGoogle Scholar
  25. 25.
    Vrantsidis F, Hill K, Haralambous B, Renehan E, Legerwood K, Pinikahana J. Living longer living stronger™: A community-delivered strength training program improving function and quality of life. Australas J Ageing. 2014; 33(1): 22-25.CrossRefPubMedGoogle Scholar
  26. 26.
    Alexandre T d S, Duarte YA d O, Santos JLF, Wong R, Lebrao ML. Prevalence and associated factors of sarcopenia among elderly in Brazil: Findings from the SABE study. J Nutr Health Aging. 2014; 18(3): 284-290.CrossRefGoogle Scholar
  27. 27.
    Andrews RD, Maclean DA, Riechman SE. Protein intake for skeletal muscle hypertrophy with resistance training in seniors. Int J Sport Nutr Exerc Metab. 2006; 16: 362-372.PubMedGoogle Scholar
  28. 28.
    Campbell WW, Leidy HJ. Dietary protein and resistance training effects on muscle and body composition in older persons. J Am Coll Nutr. 2007; 26(6): 696-703.CrossRefGoogle Scholar
  29. 29.
    Finger D, Goltz FR, Umpierre D, Meyer E, Rosa L, Schneider CD. Effects of protein supplementation in older adults undergoing resistance training: A systematic review and meta-analysis. Sports Med. 2015; 45(2): 245-255.CrossRefPubMedGoogle Scholar
  30. 30.
    Sumic A, Michael YL, Carlson NE, Howieson DB, Kaye JA. Physical activity and the risk of dementia in oldest old. J Aging Health. 2007; 19(2): 242-259.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006; 144(2): 73-81.CrossRefPubMedGoogle Scholar
  32. 32.
    Beyer I, Mets T, Bautmans I. Chronic low-grade inflammation and age-related sarcopenia. Curr Opin Clin Nutr Metab Care. 2012; 15(1): 12-22.CrossRefPubMedGoogle Scholar
  33. 33.
    Spyridaki EC, Simos P, Avgoustinaki PD, et al. The association between obesity and fluid intelligence impairment is mediated by chronic low-grade inflammation. Br J Nutr. 2014; 112(10): 1724-1734.CrossRefPubMedGoogle Scholar
  34. 34.
    Misiak B, Leszek J, Kiejna A. Metabolic syndrome, mild cognitive impairment and Alzheimer’s disease—the emerging role of systemic low-grade inflammation and adiposity. Brain Res Bull. 2012; 89(3–4): 144-149.CrossRefPubMedGoogle Scholar
  35. 35.
    Bielak AAM, Gerstorf D, Anstey KJ, Luszcz MA. Psychology and aging longitudinal associations between activity and cognition vary by age, activity type, and cognitive domain. 2014.Google Scholar
  36. 36.
    Etnier JL, Nowell PM, Landers DM, Sibley BA. A meta-regression to examine the relationship between aerobic fitness and cognitive performance. Brain Res Rev. 2006; 52(1): 119-130.CrossRefPubMedGoogle Scholar
  37. 37.
    Cournot M, Marquie JC, Ansiau D, et al. Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology. 2006; 67(7): 1208-1214.CrossRefPubMedGoogle Scholar
  38. 38.
    Benito-Leon J, Mitchell AJ, Hernandez-Gallego J, Bermejo-Pareja F. Obesity and impaired cognitive functioning in the elderly: A population-based cross-sectional study (NEDICES). Eur J Neurol. 2013; 20(6): 899-906. e76-e77.CrossRefPubMedGoogle Scholar
  39. 39.
    Wisse BE. The inflammatory syndrome: The role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. 2004; 15(11): 2792-2800.CrossRefPubMedGoogle Scholar
  40. 40.
    Schäfers M, Sorkin L. Effect of cytokines on neuronal excitability. Neurosci Lett. 2008; 437(3): 188-193.CrossRefPubMedGoogle Scholar
  41. 41.
    Black PH. The inflammatory consequences of psychologic stress: Relationship to insulin resistance, obesity, atherosclerosis and diabetes mellitus, type II. Med Hypotheses. 2006; 67(4): 879-891.CrossRefPubMedGoogle Scholar
  42. 42.
    Al Hazzouri AZ, Haan MN, Whitmer RA, Yaffe K, Neuhaus J. Central obesity, leptin and cognitive decline: The Sacramento area Latino study on aging. Dement Geriatr Cogn Disord. 2012; 33(6): 400-409.CrossRefPubMedCentralGoogle Scholar
  43. 43.
    Zeki Al Hazzouri A, Stone KL, Haan MN, Yaffe K. Leptin, mild cognitive impairment, and dementia among elderly women. J Gerontol A Biol Sci Med Sci. 2013; 68(2): 175-180.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Watson GS, Craft S. The role of insulin resistance in the pathogenesis of Alzheimer’s disease: Implications for treatment. CNS Drugs. 2003; 17(1): 27-45.CrossRefPubMedGoogle Scholar
  45. 45.
    Aleman A, Verhaar HJ, De Haan EH, et al. Insulin-like growth factor-I and cognitive function in healthy older men. J Clin Endocrinol Metab. 1999; 84(2): 471-475.CrossRefPubMedGoogle Scholar
  46. 46.
    Kalmijn S, Janssen JA, Pols HA, Lamberts SW, Breteler MM. A prospective study on circulating insulin-like growth factor I (IGF-I), IGF-binding proteins, and cognitive function in the elderly. J Clin Endocrinol Metab. 2000; 85(12): 4551-4555.CrossRefPubMedGoogle Scholar
  47. 47.
    Raji CA, Ho AJ, Parikshak NN, et al. Brain structure and obesity. Hum Brain Mapp. 2010; 31(3): 353-364.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Marks BL, Katz LM, Styner M, Smith JK. Aerobic fitness and obesity: Relationship to cerebral white matter integrity in the brain of active and sedentary older adults. Br J Sports Med. 2011; 45(15): 1208-1215.CrossRefPubMedGoogle Scholar
  49. 49.
    Iannuzzi-Sucich M, Prestwood KM, Kenny AM. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A Biol Sci Med Sci. 2002; 57(12): M772-M777.CrossRefPubMedGoogle Scholar
  50. 50.
    Hsu Y-H, Liang C-K, Chou M-Y, et al. Association of cognitive impairment, depressive symptoms and sarcopenia among healthy older men in the veterans retirement community in southern Taiwan: A cross-sectional study. Geriatr Gerontol Int. 2014; 14(Suppl 1): 102-108.CrossRefPubMedGoogle Scholar
  51. 51.
    Ershler WB, Keller ET. Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med. 2000; 51: 245-270.CrossRefPubMedGoogle Scholar
  52. 52.
    Licastro F, Pedrini S, Caputo L, et al. Increased plasma levels of interleukin-1, interleukin-6 and alpha-1-antichymotrypsin in patients with Alzheimer’s disease: Peripheral inflammation or signals from the brain? J Neuroimmunol. 2000; 103(1): 97-102.CrossRefPubMedGoogle Scholar
  53. 53.
    Bischof GN, Park DC. Obesity and aging: Consequences for cognition, brain structure, and brain function. Psychosom Med. 2015; 77(6): 697-709.CrossRefPubMedGoogle Scholar
  54. 54.
    Kalantar-Zadeh K, Horwich TB, Oreopoulos A, et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care. 2007; 10(4): 433-442.CrossRefPubMedGoogle Scholar
  55. 55.
    Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: The effect of overweight and obesity on advancing death. Am J Public Health. 2014; 104(3): 512-519.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC. The obesity paradox in the elderly: Potential mechanisms and clinical implications. Clin Geriatr Med. 2009; 25(4): 643-659. viii.CrossRefPubMedGoogle Scholar
  57. 57.
    Leo LM, Banegas R, Gutie JL, Lo E, Rodri F. Relationship of BMI, waist circumference, and weight change with use of health services by older adults. Obes Res. 2005;13(8).Google Scholar
  58. 58.
    Whitmer RA, Gunderson EP, Quesenberry CPJ, Zhou J, Yaffe K. Body mass index in midlife and risk of Alzheimer disease and vascular dementia. Curr Alzheimer Res. 2007; 4(2): 103-109.CrossRefPubMedGoogle Scholar
  59. 59.
    Gustafson DR, Backman K, Joas E, et al. 37 years of body mass index and dementia: Observations from the prospective population study of women in Gothenburg, Sweden. J Alzheimers Dis. 2012; 28(1): 163-171.PubMedGoogle Scholar
  60. 60.
    Kuo H-K, Jones RN, Milberg WP, et al. Cognitive function in normal-weight, overweight, and obese older adults: An analysis of the Advanced Cognitive Training for Independent and Vital Elderly cohort. J Am Geriatr Soc. 2006; 54(1): 97-103.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Gallucci M, Mazzuco S, Ongaro F, et al. Body mass index, lifestyles, physical performance and cognitive decline: The “Treviso Longeva (TRELONG)” study. J Nutr Health Aging. 2013; 17(4): 378-384.CrossRefPubMedGoogle Scholar
  62. 62.
    Dahl Aslan AK, Starr JM, Pattie A, Deary I. Cognitive consequences of overweight and obesity in the ninth decade of life? Age Ageing. 2015; 44(1): 59-65.CrossRefGoogle Scholar
  63. 63.
    Börsch-Supan A, Brandt M, Hunkler C, et al. Data resource profile: The Survey of Health, Ageing and Retirement in Europe (SHARE). Int J Epidemiol. 2013; 42(4): 992-1001.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Stuss DT, Alexander MP, Hamer L, et al. The effects of focal anterior and posterior brain lesions on verbal fluency. J Int Neuropsychol Soc. 1998; 4(3): 265-278.PubMedGoogle Scholar
  65. 65.
    Haugrud N, Crossley M, Vrbancic M. Clustering and switching strategies during verbal fluency performance differentiate Alzheimer’s disease and healthy aging. J Int Neuropsychol Soc. 2011; 17(6): 1153-1157.CrossRefPubMedGoogle Scholar
  66. 66.
    Green P, Montijo J, Brockhaus R. High specificity of the word memory test and medical symptom validity test in groups with severe verbal memory impairment. Appl Neuropsychol. 2011; 18(2): 86-94.CrossRefPubMedGoogle Scholar
  67. 67.
    Hoskins LL, Binder LM, Chaytor NS, Williamson DJ, Drane DL. Comparison of oral and computerized versions of the word memory test. Arch Clin Neuropsychol. 2010; 25(7): 591-600.CrossRefPubMedGoogle Scholar
  68. 68.
    Muthén LK, Muthén BO. Mplus User’s Guide. 7th ed. Los Angeles, CA: Muthén & Muthén; 1998–2012.Google Scholar
  69. 69.
    Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J. 1999; 6(1): 1-55.CrossRefGoogle Scholar
  70. 70.
    Hainer V, Aldhoon-Hainerová I. Obesity paradox does exist. Diabetes Care. 2013; 36(Suppl 2): S276-S281.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Cetin DC, Nasr G. Obesity in the elderly: More complicated than you think. Cleve Clin J Med. 2014; 81(1): 51-61.CrossRefPubMedGoogle Scholar
  72. 72.
    Villareal DT, Banks M, Sinacore DR, Siener C, Klein S. Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med. 2006; 166: 860-866.CrossRefPubMedGoogle Scholar
  73. 73.
    Han TS, Tajar A, Lean MEJ. Obesity and weight management in the elderly. Br Med Bull. 2011; 97: 169-196.CrossRefPubMedGoogle Scholar
  74. 74.
    Sechrest L, McKnight P, McKnight K. Calibration of measures for psychotherapy outcome studies. Am Psychol. 1996; 51(10): 1065-1071.CrossRefPubMedGoogle Scholar
  75. 75.
    Farias ST, Harrell E, Neumann C, Houtz A. The relationship between neuropsychological performance and daily functioning in individuals with Alzheimer’s disease: Ecological validity of neuropsychological tests. Arch Clin Neuropsychol. 2003;18:655–672.Google Scholar
  76. 76.
    Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9(3): 179-186.CrossRefPubMedGoogle Scholar
  77. 77.
    Benjamin K, Edwards NC, Bharti VK. Attitudinal, perceptual, and normative beliefs influencing the exercise decisions of community-dwelling physically frail seniors. J Aging Phys Act. 2005; 13(3): 276-293.PubMedGoogle Scholar
  78. 78.
    Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C. Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontoligt. 2013.Google Scholar
  79. 79.
    Jones M, Nies MA. The relationship of perceived benefits of and barriers to reported exercise in older African American women. Public Health Nurs. 1996; 13(2): 151-158.CrossRefPubMedGoogle Scholar
  80. 80.
    Heitmann HM. Motives of older adults for participating in physical activity programs. In: McPherson B, ed. Sports and aging. Champaign (IL): Human Kinetics; 1986: 199-204.Google Scholar
  81. 81.
    Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social-cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med (Baltim). 2000; 31(1): 15-22.CrossRefGoogle Scholar
  82. 82.
    Plante T, Coscarelli L, Ford M. Does exercising with another enhance the stress-reducing benefits of exercise? Int J Stress Manag. 2001; 8(3): 201-213.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2016

Authors and Affiliations

  • Molly Memel
    • 1
  • Kyle Bourassa
    • 1
  • Cindy Woolverton
    • 1
  • David A. Sbarra
    • 1
  1. 1.Department of PsychologyUniversity of ArizonaTucsonUSA

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