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ORIGINAL RESEARCH article

Front. Aging Neurosci.

Sec. Alzheimer's Disease and Related Dementias

Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1470256

This article is part of the Research TopicMental, Sensory, Physical and Life Style Parameters Related to Cognitive Decline in AgingView all 27 articles

The mediating role of depression on the association between physical activity and cognitive function among older adults

Provisionally accepted
HuanRui  ZhangHuanRui ZhangWen  TianWen TianGuoxian  QiGuoxian QiXiuFang  WeiXiuFang Wei*
  • Department of Geriatric, The First Hospital of China Medical University, Shenyang, Liaoning Province, China

The final, formatted version of the article will be published soon.

Background: Previous studies had showed that physical activity (PA) can effectively reduce cognitive decline. Nonetheless, it is still unclear whether depression can mediate the relationship between PA and cognitive decline. Methods: This study encompassed 2,681 older adults (≥60 years) from the National Health and Nutrition Examination Survey (NHANES) study during 2011-2012 and 2013-2014 cycles. PA was assessed, including recreation activity, work activity, and walking/bicycling. Depression was evaluated using the Patient Health Questionnaire-9, and cognitive function was assessed through a series of cognitive tests at the Mobile Examination Center. Utilizing weighted multivariable linear regression, we assessed the associations among PA, depression, and cognitive function. Additionally, a mediation model was employed to investigate how depression mediates the relationship between PA and cognitive decline. Results: We found that only moderate to high-intensity recreation activity and depression were associated with better cognitive function, including performance on the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and the overall cognitive function (composite z-score), following adjustments for potential confounding factors. Depression emerged as a mediator in the relationship of moderate to high-intensity recreation activity with AFT, DSST, and the composite z-score, mediating 6.5%, 12.3%, and 10.5% of the overall association, respectively. Furthermore, in the sensitivity analysis that excluded participants with a history of stroke, the sensitivity analysis results remained consistent and stable. Conclusion: This study found that in older adults, increasing engagement in moderate to high-intensity recreation activity, rather than work activity or walking/bicycling, is related with a reduction in cognitive decline. Notably, depression emerged as a pivotal mediating factor in this relationship.

Keywords: physical activity, Depression, Cognitive Function, Older adult, Mediation analysis, NHANES

Received: 25 Jul 2024; Accepted: 21 Aug 2025.

Copyright: © 2025 Zhang, Tian, Qi and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: XiuFang Wei, Department of Geriatric, The First Hospital of China Medical University, Shenyang, Liaoning Province, China

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